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General NPI Number Information
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NPI Number | 1205272796
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Entity Type | Organization
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Legal Business Name | PATHWAYS LIFE COACHING & SUPPORT SERVICE
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Dates
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Enumeration Date | 05/11/2013
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Last Update Date | 05/11/2013
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Provider Practice Location Address
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Address Line | 2060 HIGHWAY A1A SUITE 304
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City | INDIAN HARBOUR BEACH
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State | FL
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Zip | 32937-3596
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Country | US
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Telephone | 321-749-6862
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Fax | 321-751-6734
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Provider Business Mailing Address
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Address Line | 2060 HIGHWAY A1A SUITE 304
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City | INDIAN HARBOUR BEACH
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State | FL
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Zip | 32937-3596
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Country | US
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Telephone | 321-749-6862
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Fax | 321-751-6734
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Authorized Official
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Title or Position | DIRECTOR
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Name | MRS. SONIA GUERAO
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Credential | LMHC
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Telephone | 321-749-6862
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM0850X
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Taxonomy Name | Adult Mental Health Clinic/Center
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License Number | 11161
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License Number State | FL
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Taxonomy #2
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Taxonomy Code | 261QM0855X
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Taxonomy Name | Adolescent and Children Mental Health Clinic/Center
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License Number | 11151
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License Number State | FL
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