Provider Demographics
NPI:1396201455
Name:PATHWAYS COUNSELING SERVICES
Entity Type:Organization
Organization Name:PATHWAYS COUNSELING SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:LIZABETH
Authorized Official - Middle Name:
Authorized Official - Last Name:ROGGE
Authorized Official - Suffix:
Authorized Official - Credentials:CSAC,APSW,CCTP
Authorized Official - Phone:262-237-1186
Mailing Address - Street 1:1025 56TH ST
Mailing Address - Street 2:
Mailing Address - City:KENOSHA
Mailing Address - State:WI
Mailing Address - Zip Code:53140-3737
Mailing Address - Country:US
Mailing Address - Phone:262-237-1186
Mailing Address - Fax:
Practice Address - Street 1:1025 56TH ST
Practice Address - Street 2:
Practice Address - City:KENOSHA
Practice Address - State:WI
Practice Address - Zip Code:53140-3737
Practice Address - Country:US
Practice Address - Phone:262-237-1186
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-02-13
Last Update Date:2021-01-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Single Specialty