Provider Demographics
NPI:1093019812
Name:PATHWAY TO EQUANIMITY, LLC
Entity Type:Organization
Organization Name:PATHWAY TO EQUANIMITY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OPERATING MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:UNCHANA
Authorized Official - Middle Name:
Authorized Official - Last Name:THAMASAK
Authorized Official - Suffix:
Authorized Official - Credentials:LMHC, LCAC
Authorized Official - Phone:317-371-2373
Mailing Address - Street 1:3905 VINCENNES RD
Mailing Address - Street 2:TEN FORTUNE PARK, SUITE 303
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46268-3026
Mailing Address - Country:US
Mailing Address - Phone:317-471-3522
Mailing Address - Fax:317-471-3508
Practice Address - Street 1:3905 VINCENNES RD
Practice Address - Street 2:TEN FORTUNE PARK, SUITE 303
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46268-3026
Practice Address - Country:US
Practice Address - Phone:317-471-3522
Practice Address - Fax:317-471-3508
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-01-08
Last Update Date:2011-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN39000112A101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty