MEDICARE: PATHWAYS COUNSELING

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	1041C0700X	Clinical Social Worker

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	TXB153033	OTHER	TX	MEDICARE PTAN

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	26839	OTHER	TX	LCSW

General Provider Information

NPI Number	:	1497190318
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PATHWAYS COUNSELING

Provider Business Mailing Address
First Line	:	5628 SW GREEN OAKS BLVD STE B
Second Line	:
City	:	ARLINGTON
State	:	TX
Zip	:	76017-1162
Country	:	US
Telephone Number	:	817-933-4878
Fax Number	:

Provider Business Practice Location Address
First Line	:	5628 SW GREEN OAKS BLVD STE B
Second Line	:
City	:	ARLINGTON
State	:	TX
Zip	:	76017-1162
Country	:	US
Telephone Number	:	817-933-4878
Fax Number	:

Authorized Official
Title or Position	:	LCSW
Name	:	SUSAN R DALRYMPLE
Credential	:	MSSW
Telephone Number	:	817-933-4878

Provider Enumeration Date	:	05/06/2013
Last Update Date	:	06/07/2015

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Directions to “PATHWAYS COUNSELING ” Practice Location

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