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General NPI Number Information
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NPI Number | 1851495196
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Entity Type | Organization
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Legal Business Name | PATHS OF CHANGE INC
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Dates
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Enumeration Date | 09/08/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 102 1/2 SW FRANK PHILLIPS ROOM 4
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City | BARTLESVILLE
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State | OK
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Zip | 74003-6606
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Country | US
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Telephone | 918-336-1234
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Fax | 918-336-7604
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Provider Business Mailing Address
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Address Line | 102 1/2 SW FRANK PHILLIPS ROOM 4
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City | BARTLESVILLE
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State | OK
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Zip | 74003
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Country | US
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Telephone | 918-336-1234
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Fax | 918-336-7604
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Authorized Official
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Title or Position | PRESIDENT
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Name | MS. SHANON ELIZABETH BRADEN
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Credential | PHD LPC
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Telephone | 918-336-1234
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103T00000X
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Taxonomy Name | Psychologist
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License Number |
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License Number State |
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