MEDICARE: POTENTIAL ZONE: PATHWAYS TO GROWTH INC.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy
1	106E00000X	Assistant Behavior Analyst
2	106S00000X	Behavior Technician
3	103K00000X	Behavior Analyst

General Provider Information

NPI Number	:	1679464457
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	POTENTIAL ZONE: PATHWAYS TO GROWTH INC.

Provider Business Mailing Address
First Line	:	3622 W HEARN RD
Second Line	:
City	:	PHOENIX
State	:	AZ
Zip	:	85053-5522
Country	:	US
Telephone Number	:	623-734-2105
Fax Number	:

Provider Business Practice Location Address
First Line	:	3622 W HEARN RD
Second Line	:
City	:	PHOENIX
State	:	AZ
Zip	:	85053-5522
Country	:	US
Telephone Number	:	623-734-2105
Fax Number	:

Authorized Official
Title or Position	:	FOUNDER AND DIRECTOR
Name	:	JASMINE JACKLYN LEBRON
Credential	:
Telephone Number	:	623-734-2105

Provider Enumeration Date	:	07/10/2025
Last Update Date	:	07/10/2025

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