Healthcare Provider Details

I. General information

NPI: 1962329227
Provider Name (Legal Business Name): THE SERENE PATH WELLNESS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/29/2026
Last Update Date: 06/29/2026
Certification Date: 06/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4040 N 66TH ST
MILWAUKEE WI
53216-1157
US

IV. Provider business mailing address

805 BRADYVILLE PIKE APT M5
MURFREESBORO TN
37130-5155
US

V. Phone/Fax

Practice location:
  • Phone: 216-238-9897
  • Fax:
Mailing address:
  • Phone: 731-935-9265
  • 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

VIII. Authorized Official

Name: TERICA SHIVERS
Title or Position: OWNER
Credential:
Phone: 731-935-9265