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General NPI Number Information
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NPI Number | 1659384824
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Entity Type | Organization
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Legal Business Name | PATHWAY TO RECOVERY, INC.
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Dates
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Enumeration Date | 08/15/2006
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Last Update Date | 03/10/2010
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Provider Practice Location Address
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Address Line | 2119 OAK ST
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City | LA MARQUE
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State | TX
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Zip | 77568-4246
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Country | US
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Telephone | 409-933-4366
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Fax | 409-933-4367
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Provider Business Mailing Address
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Address Line | 2119 OAK ST
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City | LAMARQUE
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State | TX
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Zip | 77568-4246
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Country | US
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Telephone | 409-933-4366
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Fax | 409-933-4367
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Authorized Official
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Title or Position | CEO/PRESIDENT
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Name | DENNIS L MCCOLGIN
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Credential | LCDC
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Telephone | 409-933-4366
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YA0400X
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Taxonomy Name | Addiction (Substance Use Disorder) Counselor
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License Number | 1904-A
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License Number State | TX
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Taxonomy #2
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Taxonomy Code | 324500000X
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Taxonomy Name | Substance Abuse Rehabilitation Facility
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License Number | 1904A
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License Number State | TX
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Taxonomy #3
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Taxonomy Code | 324500000X
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Taxonomy Name | Substance Abuse Rehabilitation Facility
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License Number | 1904B
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License Number State | TX
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Taxonomy #4
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Taxonomy Code | 324500000X
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Taxonomy Name | Substance Abuse Rehabilitation Facility
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License Number | 1904-A
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License Number State | TX
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