Provider Demographics
NPI:1003406802
Name:PATHWAY TO PURPOSE THERAPY, INC.
Entity Type:Organization
Organization Name:PATHWAY TO PURPOSE THERAPY, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VICE PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JULIAN
Authorized Official - Middle Name:ENRIQUE
Authorized Official - Last Name:VIVES
Authorized Official - Suffix:
Authorized Official - Credentials:LMHC
Authorized Official - Phone:646-251-7806
Mailing Address - Street 1:1375 GATEWAY BLVD STE 20
Mailing Address - Street 2:
Mailing Address - City:BOYNTON BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33426-8304
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1375 GATEWAY BLVD STE 20
Practice Address - Street 2:
Practice Address - City:BOYNTON BEACH
Practice Address - State:FL
Practice Address - Zip Code:33426-8304
Practice Address - Country:US
Practice Address - Phone:561-424-6920
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-01-25
Last Update Date:2021-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty