Provider Demographics
NPI:1417141797
Name:PATHWAYS TO WHOLENESS; LIFE COACHING, INC.
Entity Type:Organization
Organization Name:PATHWAYS TO WHOLENESS; LIFE COACHING, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT / THERAPIST
Authorized Official - Prefix:MS
Authorized Official - First Name:ELIZABETH
Authorized Official - Middle Name:LYNNE
Authorized Official - Last Name:JAMIESON
Authorized Official - Suffix:
Authorized Official - Credentials:LMSW
Authorized Official - Phone:248-625-8664
Mailing Address - Street 1:6170 OVERLOOK
Mailing Address - Street 2:
Mailing Address - City:CLARKSTON
Mailing Address - State:MI
Mailing Address - Zip Code:48346-2059
Mailing Address - Country:US
Mailing Address - Phone:248-625-8664
Mailing Address - Fax:
Practice Address - Street 1:6170 OVERLOOK
Practice Address - Street 2:
Practice Address - City:CLARKSTON
Practice Address - State:MI
Practice Address - Zip Code:48346-2059
Practice Address - Country:US
Practice Address - Phone:248-625-8664
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-08-30
Last Update Date:2009-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI68010726301041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIP28340001Medicare PIN