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General NPI Number Information
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NPI Number | 1992564694
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Entity Type | Organization
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Legal Business Name | AUTHENTIC PATHWAYS THERAPY LLC
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Dates
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Enumeration Date | 03/15/2024
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Last Update Date | 03/15/2024
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Provider Practice Location Address
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Address Line | 4440 BARNES RD STE 245
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City | COLORADO SPRINGS
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State | CO
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Zip | 80917-1564
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Country | US
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Telephone | 719-428-7765
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Fax |
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Provider Business Mailing Address
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Address Line | 2660 FREDRICKSBURG DR
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City | COLORADO SPRINGS
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State | CO
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Zip | 80922-1122
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | CREDENTIALING MANAGER
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Name | TAMMY CAMPBELL
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Credential |
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Telephone | 239-257-7290
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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 |
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License Number State |
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