MEDICARE: LIFE PATHWAYS THERAPY, LLC

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	261QM0801X	Mental Health Clinic/Center (Including Community Mental Health Center)

General Provider Information

NPI Number	:	1336866086
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	LIFE PATHWAYS THERAPY, LLC

Provider Business Mailing Address
First Line	:	16674 LAKEVILLE XING
Second Line	:
City	:	WESTFIELD
State	:	IN
Zip	:	46074-8207
Country	:	US
Telephone Number	:	630-217-7268
Fax Number	:

Provider Business Practice Location Address
First Line	:	450 E 96TH ST
Second Line	:
City	:	INDIANAPOLIS
State	:	IN
Zip	:	46240-5703
Country	:	US
Telephone Number	:	317-207-0771
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	HALEY BRING
Credential	:
Telephone Number	:	630-217-7268

Provider Enumeration Date	:	10/24/2022
Last Update Date	:	10/24/2022

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