Provider Demographics
NPI:1558606475
Name:PATHWAYS TO CHANGE COUNSELING, INC.
Entity Type:Organization
Organization Name:PATHWAYS TO CHANGE COUNSELING, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:GWEN
Authorized Official - Middle Name:
Authorized Official - Last Name:AMES
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:630-229-9940
Mailing Address - Street 1:701 E IRVING PARK RD
Mailing Address - Street 2:SUITE 201
Mailing Address - City:ROSELLE
Mailing Address - State:IL
Mailing Address - Zip Code:60172-2353
Mailing Address - Country:US
Mailing Address - Phone:630-229-9940
Mailing Address - Fax:
Practice Address - Street 1:701 E IRVING PARK RD
Practice Address - Street 2:SUITE 201
Practice Address - City:ROSELLE
Practice Address - State:IL
Practice Address - Zip Code:60172-2322
Practice Address - Country:US
Practice Address - Phone:630-229-9940
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-12-04
Last Update Date:2014-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL356485406001Medicaid