Provider Demographics
NPI:1073124624
Name:HEALING PATH CLINIC LLC
Entity Type:Organization
Organization Name:HEALING PATH CLINIC LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:ODIRI
Authorized Official - Middle Name:
Authorized Official - Last Name:AKUSHE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:832-584-4092
Mailing Address - Street 1:1727 LAKE CHARLOTTE LN
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:TX
Mailing Address - Zip Code:77406-8096
Mailing Address - Country:US
Mailing Address - Phone:832-584-4092
Mailing Address - Fax:832-584-4092
Practice Address - Street 1:1727 LAKE CHARLOTTE LN
Practice Address - Street 2:
Practice Address - City:RICHMOND
Practice Address - State:TX
Practice Address - Zip Code:77406-8096
Practice Address - Country:US
Practice Address - Phone:832-584-4092
Practice Address - Fax:832-584-4092
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-08-16
Last Update Date:2020-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX5586010037OtherAETNA