Provider Demographics
NPI:1467602573
Name:THERAPEUTIC PATHWAYS, S.C.
Entity Type:Organization
Organization Name:THERAPEUTIC PATHWAYS, S.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT THERAPEUTIC PATHWAYS, S.C
Authorized Official - Prefix:DR
Authorized Official - First Name:GREGG
Authorized Official - Middle Name:E
Authorized Official - Last Name:HINTZ
Authorized Official - Suffix:
Authorized Official - Credentials:PSY D
Authorized Official - Phone:262-925-0425
Mailing Address - Street 1:PO BOX 634
Mailing Address - Street 2:
Mailing Address - City:EAST TROY
Mailing Address - State:WI
Mailing Address - Zip Code:53120-0634
Mailing Address - Country:US
Mailing Address - Phone:262-925-0425
Mailing Address - Fax:
Practice Address - Street 1:161 W WISCONSIN AVE STE 2C
Practice Address - Street 2:
Practice Address - City:PEWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53072-3467
Practice Address - Country:US
Practice Address - Phone:262-925-0405
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-09-25
Last Update Date:2008-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI2423-057251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI39137900Medicaid