MEDICARE: HEALING PATHWAYS THERAPY CENTER

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	5533760-6004	UT

General Provider Information

NPI Number	:	1437580495
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	HEALING PATHWAYS THERAPY CENTER

Provider Business Mailing Address
First Line	:	2657 S JASPER ST
Second Line	:
City	:	SALT LAKE CITY
State	:	UT
Zip	:	84106-2207
Country	:	US
Telephone Number	:	801-867-8112
Fax Number	:	801-649-5651

Provider Business Practice Location Address
First Line	:	1174 E GRAYSTONE WAY
Second Line	:	SUITE 6
City	:	SALT LAKE CITY
State	:	UT
Zip	:	84106-2673
Country	:	US
Telephone Number	:	801-867-8112
Fax Number	:

Authorized Official
Title or Position	:	FOUNDER
Name	:	KRISTAN WARNICK
Credential	:	CMHC
Telephone Number	:	801-867-8112

Provider Enumeration Date	:	12/02/2013
Last Update Date	:	10/21/2014

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