Healthcare Provider Details

I. General information

NPI: 1437966793
Provider Name (Legal Business Name): CLEAR PATHWAY LIVING LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/11/2024
Last Update Date: 12/11/2024
Certification Date: 12/11/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

16631 SW 134TH TER
PORTLAND OR
97224-1834
US

IV. Provider business mailing address

16631 SW 134TH TER
PORTLAND OR
97224-1834
US

V. Phone/Fax

Practice location:
  • Phone: 502-807-1063
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name: MUKHTAR AHMED
Title or Position: CEO
Credential:
Phone: 502-807-1063