Healthcare Provider Details

I. General information

NPI: 1760948251
Provider Name (Legal Business Name): PATH INTEGRATED HEALTHCARE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/20/2019
Last Update Date: 05/21/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

125 COLLEGE ST STE 300
BURLINGTON VT
05401-8444
US

IV. Provider business mailing address

3012 GLENMOORE AVE SUITE 14
CINCINNATI OH
45238-2269
US

V. Phone/Fax

Practice location:
  • Phone: 513-221-3000
  • Fax: 801-206-3380
Mailing address:
  • Phone: 513-221-3000
  • Fax: 513-221-2093

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code103TC1900X
TaxonomyCounseling Psychologist
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code103TP2701X
TaxonomyGroup Psychotherapy Psychologist
License Number
License Number State
# 5
Primary TaxonomyY
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number State

VIII. Authorized Official

Name: MR. MARSHAL LUNT
Title or Position: OWNER
Credential:
Phone: 801-560-3822