Provider Demographics
NPI:1578233409
Name:PATHLIGHT NEUROPSYCHIATRIC CENTER LLC
Entity Type:Organization
Organization Name:PATHLIGHT NEUROPSYCHIATRIC CENTER LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CONTRACTING AND CREDENTIALING MANAG
Authorized Official - Prefix:
Authorized Official - First Name:MARINA
Authorized Official - Middle Name:
Authorized Official - Last Name:SHEPEL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:425-214-9321
Mailing Address - Street 1:7351 E LOWRY BLVD STE 200
Mailing Address - Street 2:
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80230-6083
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1 E ERIE ST STE 242
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60611-2737
Practice Address - Country:US
Practice Address - Phone:877-825-8584
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:PATHLIGHT NEUROPSYCHIATRIC CENTER LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2021-09-13
Last Update Date:2021-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084B0040XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyBehavioral Neurology & NeuropsychiatryGroup - Single Specialty