MEDICARE: PATHWORK COUNSELING PLLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YM0800X	Mental Health Counselor

General Provider Information

NPI Number	:	1063297091
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PATHWORK COUNSELING PLLC

Provider Business Mailing Address
First Line	:	12312 S LAND AVE
Second Line	:
City	:	OKLAHOMA CITY
State	:	OK
Zip	:	73170-4514
Country	:	US
Telephone Number	:	405-252-0515
Fax Number	:	405-698-2776

Provider Business Practice Location Address
First Line	:	8524 S WESTERN AVE STE 115
Second Line	:
City	:	OKLAHOMA CITY
State	:	OK
Zip	:	73139-9248
Country	:	US
Telephone Number	:	405-252-0515
Fax Number	:	405-698-2776

Authorized Official
Title or Position	:	OWNER/MANAGING MEMBER
Name	:	SUZANNE ALAIN WATERS
Credential	:	LCSW
Telephone Number	:	240-727-9677

Provider Enumeration Date	:	08/28/2023
Last Update Date	:	03/22/2026

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