=====================================================
General NPI Number Information
=====================================================
NPI Number | 1245010081
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | PURPOSEFUL PATHWAYS COUNSELING AND WELLNESS SERVICES LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/29/2023
-----------------------------------------------------
Last Update Date | 09/29/2023
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 4247 S PRAIRIE AVE APT 3N
-----------------------------------------------------
City | CHICAGO
-----------------------------------------------------
State | IL
-----------------------------------------------------
Zip | 60653-3283
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 630-903-4789
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 4247 S PRAIRIE AVE APT 3N
-----------------------------------------------------
City | CHICAGO
-----------------------------------------------------
State | IL
-----------------------------------------------------
Zip | 60653-3283
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 630-903-4789
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | CEO/CLINICIAN
-----------------------------------------------------
Name | MALISHA L WEBBER
-----------------------------------------------------
Credential | LCPC
-----------------------------------------------------
Telephone | 630-903-4789
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 101YP2500X
-----------------------------------------------------
Taxonomy Name | Professional Counselor
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 101YM0800X
-----------------------------------------------------
Taxonomy Name | Mental Health Counselor
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------