Basic Information
| Provider Information | |||||||||
| NPI: | 1114292042 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | LIFES HEALTHY PATHWAYS LLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 134 W MAPLE ST | ||||||||
| Address2: | PO BOX 10 | ||||||||
| City: | MASON | ||||||||
| State: | MI | ||||||||
| PostalCode: | 488541657 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5176769788 | ||||||||
| FaxNumber: | 5176763438 | ||||||||
| Practice Location | |||||||||
| Address1: | 240 S BRIDGE ST | ||||||||
| Address2: | SUITE 220 | ||||||||
| City: | DEWITT | ||||||||
| State: | MI | ||||||||
| PostalCode: | 488208825 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5172770200 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 03/09/2012 | ||||||||
| LastUpdateDate: | 03/09/2012 | ||||||||
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| AuthorizedOfficialLastName: | MCLANE | ||||||||
| AuthorizedOfficialFirstName: | MARILYN | ||||||||
| AuthorizedOfficialMiddleName: | RUTH-COOMBS | ||||||||
| AuthorizedOfficialTitleorPosition: | OWNER | ||||||||
| AuthorizedOfficialTelephone: | 5172770200 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | LMSW | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 104100000X | 6801083840 | MI | Y | 193400000X SINGLE SPECIALTY GROUP | Behavioral Health & Social Service Providers | Social Worker |
No ID Information.