=====================================================
General NPI Number Information
=====================================================
NPI Number | 1972902005
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | PATHWAY TO HOPE, INC.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/14/2014
-----------------------------------------------------
Last Update Date | 08/14/2014
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2006 TOWN PLAZA CT
-----------------------------------------------------
City | WINTER SPRINGS
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 32708-6216
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 407-221-3859
-----------------------------------------------------
Fax | 407-695-0069
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 2006 TOWN PLAZA CT
-----------------------------------------------------
City | WINTER SPRINGS
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 32708-6216
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 407-221-3859
-----------------------------------------------------
Fax | 407-695-0069
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | MS. CHRISTINE L BRAUN
-----------------------------------------------------
Credential | LMHC
-----------------------------------------------------
Telephone | 407-221-3859
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 251B00000X
-----------------------------------------------------
Taxonomy Name | Case Management Agency
-----------------------------------------------------
License Number | MH 11265
-----------------------------------------------------
License Number State | FL
-----------------------------------------------------