Basic Information
| Provider Information | |||||||||
| NPI: | 1386096733 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | PATHWAYS MI ALLEGAN | ||||||||
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| Mailing Information | |||||||||
| Address1: | 213 HUBBARD ST | ||||||||
| Address2: | |||||||||
| City: | ALLEGAN | ||||||||
| State: | MI | ||||||||
| PostalCode: | 490101320 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2696731896 | ||||||||
| FaxNumber: | 2696862011 | ||||||||
| Practice Location | |||||||||
| Address1: | 213 HUBBARD ST | ||||||||
| Address2: | |||||||||
| City: | ALLEGAN | ||||||||
| State: | MI | ||||||||
| PostalCode: | 490101320 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2696731896 | ||||||||
| FaxNumber: | 2696862011 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/11/2016 | ||||||||
| LastUpdateDate: | 07/11/2016 | ||||||||
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| AuthorizedOfficialLastName: | BRILL | ||||||||
| AuthorizedOfficialFirstName: | MARIE | ||||||||
| AuthorizedOfficialMiddleName: | |||||||||
| AuthorizedOfficialTitleorPosition: | CFO | ||||||||
| AuthorizedOfficialTelephone: | 6163962301 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | Y | ||||||||
| ParentOrganizationLBN: | PATHWAYS MI | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YM0800X | N | 193200000X MULTI-SPECIALTY GROUP | Behavioral Health & Social Service Providers | Counselor | Mental Health | 101YA0400X | SA0030024 | MI | Y | 193200000X MULTI-SPECIALTY GROUP | Behavioral Health & Social Service Providers | Counselor | Addiction (Substance Use Disorder) |
No ID Information.