Provider Demographics
NPI:1235433988
Name:PATHWAYS COMMUNITY BEHAVIORAL HEALTHCARE, INC
Entity Type:Organization
Organization Name:PATHWAYS COMMUNITY BEHAVIORAL HEALTHCARE, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF EXECUTIVE OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:MEL
Authorized Official - Middle Name:
Authorized Official - Last Name:FETTER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:660-885-8131
Mailing Address - Street 1:1450 E 10TH ST.
Mailing Address - Street 2:
Mailing Address - City:ROLLA
Mailing Address - State:MO
Mailing Address - Zip Code:65401-3648
Mailing Address - Country:US
Mailing Address - Phone:573-364-7551
Mailing Address - Fax:816-318-3076
Practice Address - Street 1:1450 E 10TH ST
Practice Address - Street 2:
Practice Address - City:ROLLA
Practice Address - State:MO
Practice Address - Zip Code:65401-3648
Practice Address - Country:US
Practice Address - Phone:573-364-7551
Practice Address - Fax:816-318-3076
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-01-10
Last Update Date:2011-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO000739251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health