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General NPI Number Information
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NPI Number | 1629474929
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Entity Type | Organization
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Legal Business Name | PATHWAY 2 HEALING, INC.
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Dates
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Enumeration Date | 11/13/2014
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Last Update Date | 11/13/2014
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Provider Practice Location Address
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Address Line | 5252 BALBOA AVE SUITE 803
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City | SAN DIEGO
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State | CA
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Zip | 92117-6906
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Country | US
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Telephone | 858-333-4470
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 13061
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City | LA JOLLA
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State | CA
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Zip | 92039-3061
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Country | US
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Telephone | 619-944-1794
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | MS. SHEILA BAGHBEH
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Credential | MFT
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Telephone | 619-944-1794
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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 | 51697
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License Number State | CA
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