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General NPI Number Information
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NPI Number | 1346186194
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Entity Type | Organization
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Legal Business Name | PATHWISE BEHAVIORAL HEALTH, LLC
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Dates
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Enumeration Date | 04/24/2026
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Last Update Date | 04/24/2026
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Provider Practice Location Address
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Address Line | 609 E MAIN ST STE 106
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City | COTTAGE GROVE
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State | OR
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Zip | 97424-2039
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Country | US
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Telephone | 402-984-3004
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Fax |
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Provider Business Mailing Address
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Address Line | 609 E MAIN ST STE 106
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City | COTTAGE GROVE
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State | OR
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Zip | 97424-2039
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Country | US
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Telephone | 402-984-3004
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | CYNTHIA NESIBA
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Credential | LCSW
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Telephone | 402-984-3004
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number |
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License Number State |
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