Basic Information
| Provider Information | |||||||||
| NPI: | 1760948251 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | PATH INTEGRATED HEALTHCARE | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3012 GLENMOORE AVE | ||||||||
| Address2: | SUITE 14 | ||||||||
| City: | CINCINNATI | ||||||||
| State: | OH | ||||||||
| PostalCode: | 452382269 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5132213000 | ||||||||
| FaxNumber: | 5132212093 | ||||||||
| Practice Location | |||||||||
| Address1: | 125 COLLEGE ST STE 300 | ||||||||
| Address2: | |||||||||
| City: | BURLINGTON | ||||||||
| State: | VT | ||||||||
| PostalCode: | 054018444 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5132213000 | ||||||||
| FaxNumber: | 8012063380 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/20/2019 | ||||||||
| LastUpdateDate: | 05/21/2019 | ||||||||
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| AuthorizedOfficialLastName: | LUNT | ||||||||
| AuthorizedOfficialFirstName: | MARSHAL | ||||||||
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| AuthorizedOfficialTitleorPosition: | OWNER | ||||||||
| AuthorizedOfficialTelephone: | 8015603822 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MR. | ||||||||
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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 | 103T00000X | N | 193200000X MULTI-SPECIALTY GROUP | Behavioral Health & Social Service Providers | Psychologist | 103TC1900X | N | 193200000X MULTI-SPECIALTY GROUP | Behavioral Health & Social Service Providers | Psychologist | Counseling | 103TP2701X | N | 193200000X MULTI-SPECIALTY GROUP | Behavioral Health & Social Service Providers | Psychologist | Group Psychotherapy | 261QM0801X | Y | Ambulatory Health Care Facilities | Clinic/Center | Mental Health (Including Community Mental Health Center) |
No ID Information.