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General NPI Number Information
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NPI Number | 1124351721
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Entity Type | Organization
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Legal Business Name | PATHWAYS BEHAVIORAL HEALTH
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Dates
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Enumeration Date | 09/14/2009
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Last Update Date | 09/14/2009
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Provider Practice Location Address
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Address Line | 613 WILLIAMS BLVD
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City | KENNER
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State | LA
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Zip | 70062-7635
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Country | US
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Telephone | 504-441-5555
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Fax | 504-441-5550
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Provider Business Mailing Address
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Address Line | 613 WILLIAMS BLVD
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City | KENNER
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State | LA
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Zip | 70062-7635
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Country | US
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Telephone | 504-441-5555
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Fax | 504-441-5550
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Authorized Official
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Title or Position | DIRECTOR
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Name | LORI BORNE
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Credential |
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Telephone | 504-441-5555
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103TC1900X
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Taxonomy Name | Counseling Psychologist
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License Number | 5025
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License Number State | LA
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