Provider Demographics
NPI:1114671849
Name:GLIDEPATH BEHAVIORAL HEALTH, A PROFESSIONAL NURSING CORPORATION
Entity Type:Organization
Organization Name:GLIDEPATH BEHAVIORAL HEALTH, A PROFESSIONAL NURSING CORPORATION
Other - Org Name:GLIDEPATH BEHAVIORAL HEALTH
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT AND PRINCIPAL CLINICIAN
Authorized Official - Prefix:MR
Authorized Official - First Name:JOSEPH
Authorized Official - Middle Name:JOHN
Authorized Official - Last Name:HARRISON
Authorized Official - Suffix:
Authorized Official - Credentials:NP-C
Authorized Official - Phone:562-667-6523
Mailing Address - Street 1:3122 SUGARBERRY CT
Mailing Address - Street 2:
Mailing Address - City:WALNUT CREEK
Mailing Address - State:CA
Mailing Address - Zip Code:94598-1727
Mailing Address - Country:US
Mailing Address - Phone:562-667-6523
Mailing Address - Fax:
Practice Address - Street 1:3122 SUGARBERRY COURT
Practice Address - Street 2:
Practice Address - City:WALNUT CREEK
Practice Address - State:CA
Practice Address - Zip Code:94598-9459
Practice Address - Country:US
Practice Address - Phone:562-667-6523
Practice Address - Fax:925-291-5500
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-02-10
Last Update Date:2022-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Multi-Specialty
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty
No164X00000XNursing Service ProvidersLicensed Vocational NurseGroup - Multi-Specialty
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Multi-Specialty