MEDICARE: PATHWAY BEHAVIORAL GROUP 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	103K00000X	Behavior Analyst

General Provider Information

NPI Number	:	1790644581
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PATHWAY BEHAVIORAL GROUP LLC

Provider Business Mailing Address
First Line	:	845 15TH ST STE 415C
Second Line	:
City	:	SAN DIEGO
State	:	CA
Zip	:	92101-8098
Country	:	US
Telephone Number	:	612-404-8354
Fax Number	:

Provider Business Practice Location Address
First Line	:	845 15TH ST STE 415C
Second Line	:
City	:	SAN DIEGO
State	:	CA
Zip	:	92101-8098
Country	:	US
Telephone Number	:	612-404-8354
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	YASSIR ABDI
Credential	:
Telephone Number	:	612-404-8354

Provider Enumeration Date	:	01/19/2026
Last Update Date	:	01/19/2026

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Directions to “PATHWAY BEHAVIORAL GROUP LLC ” Practice Location

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