MEDICARE: PATHWAYS HEALING SERVICES 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	261QM0850X	Adult Mental Health Clinic/Center

General Provider Information

NPI Number	:	1972383255
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PATHWAYS HEALING SERVICES LLC

Provider Business Mailing Address
First Line	:	1000 E 146TH ST STE 133
Second Line	:
City	:	BURNSVILLE
State	:	MN
Zip	:	55337-5526
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1000 E 146TH ST STE 133
Second Line	:
City	:	BURNSVILLE
State	:	MN
Zip	:	55337-5526
Country	:	US
Telephone Number	:	612-644-0026
Fax Number	:

Authorized Official
Title or Position	:	AUTHORIZED OFFICIAL
Name	:	AYAN M HASSAN
Credential	:
Telephone Number	:	612-644-0026

Provider Enumeration Date	:	10/03/2023
Last Update Date	:	03/09/2026

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