MEDICARE: PEACEFUL PATHWAYS BEHAVIORAL HEALTH SERVICES

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	:	1356115125
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PEACEFUL PATHWAYS BEHAVIORAL HEALTH SERVICES

Provider Business Mailing Address
First Line	:	2529 LAKE ST
Second Line	:
City	:	LAKE CHARLES
State	:	LA
Zip	:	70601-8211
Country	:	US
Telephone Number	:	337-761-4981
Fax Number	:	337-735-9760

Provider Business Practice Location Address
First Line	:	2529 LAKE ST
Second Line	:
City	:	LAKE CHARLES
State	:	LA
Zip	:	70601-8211
Country	:	US
Telephone Number	:	337-761-4981
Fax Number	:	337-735-9760

Authorized Official
Title or Position	:	CEO
Name	:	QUALYNN S. JENKINS
Credential	:
Telephone Number	:	337-761-4981

Provider Enumeration Date	:	11/13/2023
Last Update Date	:	10/02/2025

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