Provider Demographics
NPI:1003138884
Name:PATHWAYS BEHAVIORAL CENTER, LLC
Entity Type:Organization
Organization Name:PATHWAYS BEHAVIORAL CENTER, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:LORI
Authorized Official - Middle Name:A
Authorized Official - Last Name:BORNE
Authorized Official - Suffix:
Authorized Official - Credentials:MS
Authorized Official - Phone:504-252-3337
Mailing Address - Street 1:3715 WILLIAMS BLVD
Mailing Address - Street 2:SUITE 102
Mailing Address - City:KENNER
Mailing Address - State:LA
Mailing Address - Zip Code:70065-3075
Mailing Address - Country:US
Mailing Address - Phone:504-252-3337
Mailing Address - Fax:504-305-1066
Practice Address - Street 1:3715 WILLIAMS BLVD
Practice Address - Street 2:SUITE 102
Practice Address - City:KENNER
Practice Address - State:LA
Practice Address - Zip Code:70065-3075
Practice Address - Country:US
Practice Address - Phone:504-252-3337
Practice Address - Fax:504-305-1066
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-02-22
Last Update Date:2016-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA3086101Y00000X
LAMD0207502084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Multi-Specialty
No101Y00000XBehavioral Health & Social Service ProvidersCounselorGroup - Multi-Specialty