MEDICARE: PATHWAYS LIFE COACHING & SUPPORT SERVICE

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	261QM0850X	Adult Mental Health Clinic/Center	11161	FL
2	261QM0855X	Adolescent and Children Mental Health Clinic/Center	11151	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	11161	OTHER	FL	DOH
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1205272796
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PATHWAYS LIFE COACHING & SUPPORT SERVICE

Provider Business Mailing Address
First Line	:	2060 HIGHWAY A1A
Second Line	:	SUITE 304
City	:	INDIAN HARBOUR BEACH
State	:	FL
Zip	:	32937-3596
Country	:	US
Telephone Number	:	321-749-6862
Fax Number	:	321-751-6734

Provider Business Practice Location Address
First Line	:	2060 HIGHWAY A1A
Second Line	:	SUITE 304
City	:	INDIAN HARBOUR BEACH
State	:	FL
Zip	:	32937-3596
Country	:	US
Telephone Number	:	321-749-6862
Fax Number	:	321-751-6734

Authorized Official
Title or Position	:	DIRECTOR
Name	:	MRS. SONIA GUERAO
Credential	:	LMHC
Telephone Number	:	321-749-6862

Provider Enumeration Date	:	05/11/2013
Last Update Date	:	05/11/2013

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Directions to “PATHWAYS LIFE COACHING & SUPPORT SERVICE ” Practice Location

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