=====================================================
General NPI Number Information
=====================================================
NPI Number | 1497595268
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | MOUNTAIN PATH THERAPY PLLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/29/2024
-----------------------------------------------------
Last Update Date | 08/05/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 10483 MUSTANG RUN
-----------------------------------------------------
City | FORNEY
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 75126-7467
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 630-457-0593
-----------------------------------------------------
Fax | 267-649-3139
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 10483 MUSTANG RUN
-----------------------------------------------------
City | FORNEY
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 75126-7467
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 630-457-0593
-----------------------------------------------------
Fax | 267-649-3139
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | MR. JOEL THOMAS
-----------------------------------------------------
Credential | M.S., LPC, NCC
-----------------------------------------------------
Telephone | 682-990-6850
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 101YP2500X
-----------------------------------------------------
Taxonomy Name | Professional Counselor
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------