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General NPI Number Information
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NPI Number | 1003138884
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Entity Type | Organization
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Legal Business Name | PATHWAYS BEHAVIORAL CENTER, LLC
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Dates
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Enumeration Date | 02/22/2010
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Last Update Date | 02/18/2016
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Provider Practice Location Address
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Address Line | 3715 WILLIAMS BLVD SUITE 102
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City | KENNER
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State | LA
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Zip | 70065-3075
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Country | US
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Telephone | 504-252-3337
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Fax | 504-305-1066
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Provider Business Mailing Address
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Address Line | 3715 WILLIAMS BLVD SUITE 102
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City | KENNER
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State | LA
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Zip | 70065-3075
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Country | US
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Telephone | 504-252-3337
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Fax | 504-305-1066
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Authorized Official
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Title or Position | OWNER
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Name | MRS. LORI A BORNE
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Credential | MS
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Telephone | 504-252-3337
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101Y00000X
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Taxonomy Name | Counselor
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License Number | 3086
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License Number State | LA
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Taxonomy #2
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Taxonomy Code | 2084P0800X
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Taxonomy Name | Psychiatry Physician
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License Number | MD020750
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License Number State | LA
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