Basic Information
| Provider Information | |||||||||
| NPI: | 1043822208 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | PATHWAYS HUMAN SERVICES OF PENNSYLVANIA, LLC | ||||||||
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| OtherOrganizationName: | FAMILY BEHAVIORAL RESOURCES | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 10304 SPOTSYLVANIA AVE STE 300 | ||||||||
| Address2: | |||||||||
| City: | FREDERICKSBURG | ||||||||
| State: | VA | ||||||||
| PostalCode: | 224088605 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5407106085 | ||||||||
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| Practice Location | |||||||||
| Address1: | 131 MATHEWS ST STE 2000 | ||||||||
| Address2: | |||||||||
| City: | GREENSBURG | ||||||||
| State: | PA | ||||||||
| PostalCode: | 156016939 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7248508118 | ||||||||
| FaxNumber: | 7248509500 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/19/2020 | ||||||||
| LastUpdateDate: | 09/24/2020 | ||||||||
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| AuthorizedOfficialLastName: | MONTES | ||||||||
| AuthorizedOfficialFirstName: | JOYCE | ||||||||
| AuthorizedOfficialMiddleName: | A. | ||||||||
| AuthorizedOfficialTitleorPosition: | GENERAL COUNSEL | ||||||||
| AuthorizedOfficialTelephone: | 5407106085 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | J.D., C.H.C. | ||||||||
| NPICertificationDate: | 09/22/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 261QM0855X | N | Ambulatory Health Care Facilities | Clinic/Center | Adolescent and Children Mental Health | 251S00000X | N | Agencies | Community/Behavioral Health | 261Q00000X | N | Ambulatory Health Care Facilities | Clinic/Center | 261QM0801X | N | Ambulatory Health Care Facilities | Clinic/Center | Mental Health (Including Community Mental Health Center) | 103T00000X | N | 193400000X MULTIPLE SINGLE SPECIALTY GROUP | Behavioral Health & Social Service Providers | Psychologist | 2084P0005X | N | 193400000X MULTIPLE SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Psychiatry & Neurology | Neurodevelopmental Disabilities | 2084P0800X | N | 193400000X MULTIPLE SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Psychiatry & Neurology | Psychiatry | 2084P0804X | N | 193400000X MULTIPLE SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Psychiatry & Neurology | Child & Adolescent Psychiatry | 251B00000X | N | Agencies | Case Management | 251K00000X | Y | Agencies | Public Health or Welfare |
No ID Information.