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General NPI Number Information
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NPI Number | 1003406802
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Entity Type | Organization
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Legal Business Name | PATHWAY TO PURPOSE THERAPY, INC.
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Dates
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Enumeration Date | 01/25/2021
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Last Update Date | 01/25/2021
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Provider Practice Location Address
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Address Line | 1375 GATEWAY BLVD STE 20
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City | BOYNTON BEACH
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State | FL
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Zip | 33426-8304
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Country | US
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Telephone | 561-424-6920
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Fax |
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Provider Business Mailing Address
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Address Line | 1375 GATEWAY BLVD STE 20
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City | BOYNTON BEACH
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State | FL
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Zip | 33426-8304
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | VICE PRESIDENT
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Name | JULIAN ENRIQUE VIVES
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Credential | LMHC
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Telephone | 646-251-7806
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number |
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License Number State |
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