Provider Demographics
NPI:1063689677
Name:PATHWAYS LIFE COUNSELING LLC
Entity Type:Organization
Organization Name:PATHWAYS LIFE COUNSELING LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:RODGER
Authorized Official - Middle Name:
Authorized Official - Last Name:HICKS
Authorized Official - Suffix:
Authorized Official - Credentials:MA LMHC
Authorized Official - Phone:315-393-5116
Mailing Address - Street 1:5428 STATE HWY 37
Mailing Address - Street 2:LOFT SUITE 8
Mailing Address - City:OGDENSBURG
Mailing Address - State:NY
Mailing Address - Zip Code:13669-4211
Mailing Address - Country:US
Mailing Address - Phone:315-393-5116
Mailing Address - Fax:315-393-5940
Practice Address - Street 1:5428 STATE HIGHWAY 37
Practice Address - Street 2:LOFT SUITE 8
Practice Address - City:OGDENSBURG
Practice Address - State:NY
Practice Address - Zip Code:13669-4211
Practice Address - Country:US
Practice Address - Phone:315-393-5116
Practice Address - Fax:315-393-5940
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-05-13
Last Update Date:2008-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY176644103T00000X
NY015732103T00000X
NY070198-1104100000X
NY0032611041C0700X
NY057519-11041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty
No103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Multi-Specialty
No104100000XBehavioral Health & Social Service ProvidersSocial WorkerGroup - Multi-Specialty