Provider Demographics
NPI:1225736267
Name:PATH TO HEALING AND WELLNESS PLLC
Entity Type:Organization
Organization Name:PATH TO HEALING AND WELLNESS PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:KIMBERLY
Authorized Official - Middle Name:
Authorized Official - Last Name:MERCER
Authorized Official - Suffix:
Authorized Official - Credentials:LMFT
Authorized Official - Phone:815-310-0718
Mailing Address - Street 1:400 5TH ST STE 192
Mailing Address - Street 2:
Mailing Address - City:PERU
Mailing Address - State:IL
Mailing Address - Zip Code:61354-2876
Mailing Address - Country:US
Mailing Address - Phone:815-310-0718
Mailing Address - Fax:
Practice Address - Street 1:400 5TH ST STE 192
Practice Address - Street 2:
Practice Address - City:PERU
Practice Address - State:IL
Practice Address - Zip Code:61354-2876
Practice Address - Country:US
Practice Address - Phone:815-303-0718
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-02-20
Last Update Date:2023-12-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL1275706053Medicaid