MEDICARE: YOUR PATH TELETHERAPY

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	101YP2500X	Professional Counselor

General Provider Information

NPI Number	:	1447911524
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	YOUR PATH TELETHERAPY

Provider Business Mailing Address
First Line	:	7505 CRAIG DR
Second Line	:
City	:	FORT BENNING
State	:	GA
Zip	:	31905-7905
Country	:	US
Telephone Number	:	901-273-7284
Fax Number	:

Provider Business Practice Location Address
First Line	:	7505 CRAIG DR
Second Line	:
City	:	FORT BENNING
State	:	GA
Zip	:	31905-7905
Country	:	US
Telephone Number	:	901-273-7284
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	ANASTASIA JARRETT
Credential	:
Telephone Number	:	931-273-7284

Provider Enumeration Date	:	01/01/2022
Last Update Date	:	01/01/2022

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Directions to “YOUR PATH TELETHERAPY ” Practice Location

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