=====================================================
General NPI Number Information
=====================================================
NPI Number | 1528837036
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | PURPOSEFUL PATHWAYS COUNSELING PLLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 12/26/2023
-----------------------------------------------------
Last Update Date | 12/26/2023
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 18161 MORRIS AVE STE 207
-----------------------------------------------------
City | HOMEWOOD
-----------------------------------------------------
State | IL
-----------------------------------------------------
Zip | 60430-2141
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 773-368-4878
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 18434 CLYDE RD
-----------------------------------------------------
City | HOMEWOOD
-----------------------------------------------------
State | IL
-----------------------------------------------------
Zip | 60430-3014
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 773-368-4878
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | MANAGER/THERAPIST
-----------------------------------------------------
Name | FARRAH ELLISON-MOORE
-----------------------------------------------------
Credential | LCPC
-----------------------------------------------------
Telephone | 773-368-4878
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 101Y00000X
-----------------------------------------------------
Taxonomy Name | Counselor
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 101YM0800X
-----------------------------------------------------
Taxonomy Name | Mental Health Counselor
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------
Taxonomy #3
-----------------------------------------------------
Taxonomy Code | 101YP1600X
-----------------------------------------------------
Taxonomy Name | Pastoral Counselor
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------
Taxonomy #4
-----------------------------------------------------
Taxonomy Code | 101YS0200X
-----------------------------------------------------
Taxonomy Name | School Counselor
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------
Taxonomy #5
-----------------------------------------------------
Taxonomy Code | 101YP2500X
-----------------------------------------------------
Taxonomy Name | Professional Counselor
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------