Provider Demographics
NPI:1366443723
Name:PATHWAYS PSYCHOLOGICAL SERVICES, P.A.
Entity Type:Organization
Organization Name:PATHWAYS PSYCHOLOGICAL SERVICES, P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:SAVANAH
Authorized Official - Middle Name:E
Authorized Official - Last Name:WIMBUSH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:763-525-8590
Mailing Address - Street 1:10700 OLD COUNTY ROAD 15 STE 170
Mailing Address - Street 2:
Mailing Address - City:PLYMOUTH
Mailing Address - State:MN
Mailing Address - Zip Code:55441-8709
Mailing Address - Country:US
Mailing Address - Phone:763-525-8590
Mailing Address - Fax:763-525-9592
Practice Address - Street 1:10700 OLD COUNTY ROAD 15 STE 170
Practice Address - Street 2:
Practice Address - City:PLYMOUTH
Practice Address - State:MN
Practice Address - Zip Code:55441-8709
Practice Address - Country:US
Practice Address - Phone:763-525-8590
Practice Address - Fax:763-525-9592
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-08-09
Last Update Date:2023-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN776781100Medicaid
MN108992OtherUCARE
MN35674OtherHEALTHPARTNERS
MN8H914PAOtherBLUE CROSS BLUE SHIELD