Provider Demographics
NPI:1427395847
Name:INNER PATHWAYS PC
Entity Type:Organization
Organization Name:INNER PATHWAYS PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:SUSAN
Authorized Official - Middle Name:ANNE
Authorized Official - Last Name:WITT
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:541-490-5831
Mailing Address - Street 1:PO BOX 1245
Mailing Address - Street 2:
Mailing Address - City:HOOD RIVER
Mailing Address - State:OR
Mailing Address - Zip Code:97031-0083
Mailing Address - Country:US
Mailing Address - Phone:541-490-5831
Mailing Address - Fax:
Practice Address - Street 1:702 COLUMBIA ST
Practice Address - Street 2:
Practice Address - City:HOOD RIVER
Practice Address - State:OR
Practice Address - Zip Code:97031-1720
Practice Address - Country:US
Practice Address - Phone:541-490-5831
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-01-04
Last Update Date:2019-05-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR03-03-46101YA0400X
ORL24191041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR500674555Medicaid