MEDICARE: PATHWAYS BEHAVIORAL CONSULTING, 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	251S00000X	Community/Behavioral Health Agency	1-10-6841	GA

General Provider Information

NPI Number	:	1508267139
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PATHWAYS BEHAVIORAL CONSULTING, LLC

Provider Business Mailing Address
First Line	:	2472 JETT FERRY RD STE 400-197
Second Line	:
City	:	ATLANTA
State	:	GA
Zip	:	30338-3059
Country	:	US
Telephone Number	:	404-465-1818
Fax Number	:

Provider Business Practice Location Address
First Line	:	2472 JETT FERRY RD STE 400-197
Second Line	:
City	:	ATLANTA
State	:	GA
Zip	:	30338-3059
Country	:	US
Telephone Number	:	404-465-1818
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT AND FOUNDER
Name	:	MRS. REBECCA CRISSEY LAMONT
Credential	:	M.ED., BCBA
Telephone Number	:	571-228-5969

Provider Enumeration Date	:	09/15/2014
Last Update Date	:	09/15/2014

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