MEDICARE: POSITIVE PATHWAYS 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	101YM0800X	Mental Health Counselor	193400000X	KY

General Provider Information

NPI Number	:	1386706893
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	POSITIVE PATHWAYS LLC

Provider Business Mailing Address
First Line	:	7000 HOUSTON RD
Second Line	:	SUITE 29
City	:	FLORENCE
State	:	KY
Zip	:	41042-4879
Country	:	US
Telephone Number	:	859-746-9272
Fax Number	:	859-746-9322

Provider Business Practice Location Address
First Line	:	800 COMPTON RD UNIT 12
Second Line	:
City	:	CINCINNATI
State	:	OH
Zip	:	45231-3846
Country	:	US
Telephone Number	:	513-521-3175
Fax Number	:	513-521-3477

Authorized Official
Title or Position	:	OWNER
Name	:	MRS. ANNE M MANGOLD
Credential	:	LCSW
Telephone Number	:	859-512-0334

Provider Enumeration Date	:	12/14/2006
Last Update Date	:	03/17/2018

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Directions to “POSITIVE PATHWAYS LLC ” Practice Location

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