Basic Information
| Provider Information | |||||||||
| NPI: | 1275209496 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | AFFIRMING PATHWAYS PSYCHOTHERAPY | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1873 BURG ST | ||||||||
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| City: | GRANVILLE | ||||||||
| State: | OH | ||||||||
| PostalCode: | 430231029 | ||||||||
| CountryCode: | US | ||||||||
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| Practice Location | |||||||||
| Address1: | 58 S 2ND ST | ||||||||
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| City: | NEWARK | ||||||||
| State: | OH | ||||||||
| PostalCode: | 430555432 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7403064267 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 08/18/2021 | ||||||||
| LastUpdateDate: | 08/18/2021 | ||||||||
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| AuthorizedOfficialLastName: | HAYES | ||||||||
| AuthorizedOfficialFirstName: | KIRA | ||||||||
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| AuthorizedOfficialTitleorPosition: | OWNER | ||||||||
| AuthorizedOfficialTelephone: | 7403349321 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | MA, MFT | ||||||||
| NPICertificationDate: | 08/18/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 106H00000X | N | 193200000X MULTI-SPECIALTY GROUP | Behavioral Health & Social Service Providers | Marriage & Family Therapist | 261QM0801X | Y | Ambulatory Health Care Facilities | Clinic/Center | Mental Health (Including Community Mental Health Center) |
ID Information
| ID | Type | State | Issuer | Description | 1265904304 | 01 | OH | EMPLOYEE NPI | OTHER |