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General NPI Number Information
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NPI Number | 1619497534
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Entity Type | Organization
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Legal Business Name | PATHWAVES INCORPORATED
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Dates
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Enumeration Date | 06/21/2017
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Last Update Date | 07/19/2017
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Provider Practice Location Address
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Address Line | 2503 SOUTHWEST 27 AVENUE
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City | MIAMI
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State | FL
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Zip | 33133
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Country | US
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Telephone | 305-858-6616
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Fax |
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Provider Business Mailing Address
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Address Line | 2503 SW 27TH AVE
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City | MIAMI
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State | FL
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Zip | 33133-2119
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | ASSISTANT CLINICAL DIRECTOR
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Name | RYAN PAUL LANDAU
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Credential | LMHC
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Telephone | 305-858-6616
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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 | MH9225
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License Number State | FL
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