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General NPI Number Information
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NPI Number | 1093390478
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Entity Type | Organization
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Legal Business Name | PATH OF LIFE COUNSELING PSC
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Dates
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Enumeration Date | 03/16/2021
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Last Update Date | 04/18/2025
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Provider Practice Location Address
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Address Line | 2042 WOODDALE DR STE 250
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City | WOODBURY
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State | MN
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Zip | 55125-4421
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Country | US
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Telephone | 651-212-7111
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Fax |
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Provider Business Mailing Address
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Address Line | 2042 WOODDALE DR STE 250
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City | WOODBURY
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State | MN
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Zip | 55125-4421
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Country | US
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Telephone | 651-300-3328
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Fax | 651-419-1314
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Authorized Official
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Title or Position | OWNER/PROFESSIONAL COUNSELOR
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Name | MAYLEE CHANG THAO
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Credential | LPCC
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Telephone | 651-300-3328
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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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