=====================================================
General NPI Number Information
=====================================================
NPI Number | 1790269256
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | PATHBUILDERS COUNSELING SERVICES, INC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/20/2018
-----------------------------------------------------
Last Update Date | 09/20/2018
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1300 N. MILLER ROAD
-----------------------------------------------------
City | BUCKEYE
-----------------------------------------------------
State | AZ
-----------------------------------------------------
Zip | 85326
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 480-261-0105
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | P.O. BOX 1118
-----------------------------------------------------
City | BUCKEYE
-----------------------------------------------------
State | AZ
-----------------------------------------------------
Zip | 85326
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 480-261-0105
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | MARRIAGE, FAMILY THERAPIST
-----------------------------------------------------
Name | MRS. RACHEL L. BENTLEY
-----------------------------------------------------
Credential | LMFT
-----------------------------------------------------
Telephone | 480-261-0105
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 106H00000X
-----------------------------------------------------
Taxonomy Name | Marriage & Family Therapist
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------