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General NPI Number Information
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NPI Number | 1730325432
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Entity Type | Organization
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Legal Business Name | PATHWAYS OHIO COUNSELING SERVICES, LLC
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Dates
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Enumeration Date | 12/30/2008
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Last Update Date | 11/09/2016
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Provider Practice Location Address
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Address Line | 58 S MAIN ST SUITE 4
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City | POLAND
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State | OH
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Zip | 44514-1978
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Country | US
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Telephone | 330-921-8308
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Fax | 330-757-1166
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Provider Business Mailing Address
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Address Line | 58 SOUTH MAIN ST SUITE 4
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City | POLAND
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State | OH
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Zip | 44514-7479
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Country | US
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Telephone | 330-921-8308
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Fax | 330-757-1166
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Authorized Official
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Title or Position | OWNER
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Name | MRS. REBECCA NELIS
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Credential | MSSA, LISW-S
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Telephone | 330-921-8308
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | I0500051
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License Number State | OH
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