=====================================================
General NPI Number Information
=====================================================
NPI Number | 1396334157
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | PATHWAYS TO CONNECTION, LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/14/2021
-----------------------------------------------------
Last Update Date | 03/14/2024
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 7007 W CINNABAR AVE
-----------------------------------------------------
City | PEORIA
-----------------------------------------------------
State | AZ
-----------------------------------------------------
Zip | 85345-6894
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 602-218-1249
-----------------------------------------------------
Fax | 623-321-9964
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 7007 W CINNABAR AVE
-----------------------------------------------------
City | PEORIA
-----------------------------------------------------
State | AZ
-----------------------------------------------------
Zip | 85345-6894
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 602-218-1249
-----------------------------------------------------
Fax | 623-321-9964
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | DR. MELISSA DRINKMAN
-----------------------------------------------------
Credential | LCSW, DBH
-----------------------------------------------------
Telephone | 602-218-1249
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 1041C0700X
-----------------------------------------------------
Taxonomy Name | Clinical Social Worker
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------