Provider Demographics
NPI:1467761296
Name:POSITIVE PATHWAYS COUNSELING AND CONSULTING, LLC
Entity Type:Organization
Organization Name:POSITIVE PATHWAYS COUNSELING AND CONSULTING, LLC
Other - Org Name:POSITIVE PATHWAYS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:COUNSELOR
Authorized Official - Prefix:
Authorized Official - First Name:STEPHANIE
Authorized Official - Middle Name:
Authorized Official - Last Name:SHANK
Authorized Official - Suffix:
Authorized Official - Credentials:MS, LMHC
Authorized Official - Phone:317-440-4176
Mailing Address - Street 1:654 OVERCUP ST
Mailing Address - Street 2:
Mailing Address - City:WESTFIELD
Mailing Address - State:IN
Mailing Address - Zip Code:46074-5803
Mailing Address - Country:US
Mailing Address - Phone:317-440-4176
Mailing Address - Fax:775-288-3479
Practice Address - Street 1:13295 ILLINOIS ST
Practice Address - Street 2:SUITE 132
Practice Address - City:CARMEL
Practice Address - State:IN
Practice Address - Zip Code:46032-3019
Practice Address - Country:US
Practice Address - Phone:317-440-4176
Practice Address - Fax:775-288-3479
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-09-28
Last Update Date:2012-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN39001720A101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN201016750AMedicaid