Provider Demographics
NPI:1376112920
Name:LIMINAL PATH CREATIVE COUNSELING SERVICES
Entity Type:Organization
Organization Name:LIMINAL PATH CREATIVE COUNSELING SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:AMANDA
Authorized Official - Middle Name:KATHRYN
Authorized Official - Last Name:WEBBER
Authorized Official - Suffix:
Authorized Official - Credentials:MA,LMHC,ATR-BC
Authorized Official - Phone:442-400-9195
Mailing Address - Street 1:PO BOX 1711
Mailing Address - Street 2:
Mailing Address - City:JOSHUA TREE
Mailing Address - State:CA
Mailing Address - Zip Code:92252-0853
Mailing Address - Country:US
Mailing Address - Phone:442-400-9195
Mailing Address - Fax:
Practice Address - Street 1:64757 LEARCO WAY
Practice Address - Street 2:
Practice Address - City:JOSHUA TREE
Practice Address - State:CA
Practice Address - Zip Code:92252
Practice Address - Country:US
Practice Address - Phone:442-400-9195
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-06-18
Last Update Date:2024-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty