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General NPI Number Information
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NPI Number | 1366443723
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Entity Type | Organization
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Legal Business Name | PATHWAYS PSYCHOLOGICAL SERVICES, P.A.
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Dates
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Enumeration Date | 08/09/2005
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Last Update Date | 07/01/2023
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Provider Practice Location Address
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Address Line | 10700 OLD COUNTY ROAD 15 STE 170
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City | PLYMOUTH
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State | MN
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Zip | 55441-8709
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Country | US
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Telephone | 763-525-8590
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Fax | 763-525-9592
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Provider Business Mailing Address
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Address Line | 10700 OLD COUNTY ROAD 15 STE 170
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City | PLYMOUTH
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State | MN
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Zip | 55441-8709
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Country | US
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Telephone | 763-525-8590
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Fax | 763-525-9592
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Authorized Official
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Title or Position | OFFICE MANAGER
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Name | SAVANAH E WIMBUSH
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Credential |
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Telephone | 763-525-8590
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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 | MN
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