Healthcare Provider Details

I. General information

NPI: 1285455998
Provider Name (Legal Business Name): INNOVATIVE PATHWAYS, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/24/2024
Last Update Date: 08/11/2025
Certification Date: 10/22/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3 MORGAN CT
JOHNSON CITY TN
37604
US

IV. Provider business mailing address

3 MORGAN CT
JOHNSON CITY TN
37604
US

V. Phone/Fax

Practice location:
  • Phone: 423-656-0090
  • Fax: 423-656-0091
Mailing address:
  • Phone: 423-656-0090
  • Fax: 423-656-0091

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number State

VIII. Authorized Official

Name: VICKI L ROSS
Title or Position: ADMINISTRATIVE DIRECTOR/CO-OWNER
Credential:
Phone: 423-656-0090