Provider Demographics
NPI:1619688124
Name:YOUR PATH THERAPEUTIC SERVICES INC
Entity Type:Organization
Organization Name:YOUR PATH THERAPEUTIC SERVICES INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/THERAPIST
Authorized Official - Prefix:MRS
Authorized Official - First Name:JESSICA
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:BERNARD
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:847-802-2195
Mailing Address - Street 1:825 N CASS AVE STE 115
Mailing Address - Street 2:
Mailing Address - City:WESTMONT
Mailing Address - State:IL
Mailing Address - Zip Code:60559-6401
Mailing Address - Country:US
Mailing Address - Phone:847-660-6701
Mailing Address - Fax:
Practice Address - Street 1:825 N CASS AVE STE 115
Practice Address - Street 2:
Practice Address - City:WESTMONT
Practice Address - State:IL
Practice Address - Zip Code:60559-6401
Practice Address - Country:US
Practice Address - Phone:847-660-6701
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-12-06
Last Update Date:2022-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL1699295360OtherBCBS IL, CIGNA, UBH, EVERNOTH