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General NPI Number Information
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NPI Number | 1538049374
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Entity Type | Organization
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Legal Business Name | FORWARD PATHWAYS - W CAMELBACK CLINIC LLC
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Dates
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Enumeration Date | 09/03/2025
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Last Update Date | 10/06/2025
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Provider Practice Location Address
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Address Line | 1990 W CAMELBACK RD STE 218
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City | PHOENIX
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State | AZ
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Zip | 85015-3464
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Country | US
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Telephone | 623-887-2678
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Fax |
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Provider Business Mailing Address
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Address Line | 1990 W CAMELBACK RD STE 218
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City | PHOENIX
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State | AZ
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Zip | 85015-3464
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Country | US
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Telephone | 623-887-2678
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Fax |
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Authorized Official
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Title or Position | PROGRAM ADMINISTRATOR
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Name | DAVID T JOHNSON
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Credential |
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Telephone | 623-887-2678
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM0801X
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Taxonomy Name | Mental Health Clinic/Center (Including Community Mental Health Center)
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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 | 261QM0850X
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Taxonomy Name | Adult Mental Health Clinic/Center
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number |
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License Number State |
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