Provider Demographics
NPI:1598874133
Name:PATHWAYS...A COUNSELING AND LEARNING CENTER, INC.
Entity Type:Organization
Organization Name:PATHWAYS...A COUNSELING AND LEARNING CENTER, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:C
Authorized Official - Last Name:FLOWERS
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:801-558-8650
Mailing Address - Street 1:PO BOX 9128
Mailing Address - Street 2:
Mailing Address - City:SALT LAKE CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84109-0128
Mailing Address - Country:US
Mailing Address - Phone:801-485-2674
Mailing Address - Fax:801-485-2674
Practice Address - Street 1:1104 ASHTON AVE
Practice Address - Street 2:114
Practice Address - City:SALT LAKE CITY
Practice Address - State:UT
Practice Address - Zip Code:84106-4504
Practice Address - Country:US
Practice Address - Phone:801-558-8650
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-29
Last Update Date:2008-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT117375-35011041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
UT788002288030Medicaid
UTR34618Medicare UPIN
UT005553411Medicare ID - Type UnspecifiedCOUNSELING