Healthcare Provider Details

I. General information

NPI: 1508496324
Provider Name (Legal Business Name): PATHWAYS COUNSELING AND WELLNESS PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/21/2020
Last Update Date: 01/21/2020
Certification Date: 01/21/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10000 NE 7TH AVE
VANCOUVER WA
98685-4599
US

IV. Provider business mailing address

PO BOX 820221
VANCOUVER WA
98682-0005
US

V. Phone/Fax

Practice location:
  • Phone: 360-358-2922
  • Fax:
Mailing address:
  • Phone: 360-358-2922
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code261QM0855X
TaxonomyAdolescent and Children Mental Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: LACEY M MEEHAN
Title or Position: OWNER/THERAPIST
Credential: LMFT
Phone: 360-358-2922