Provider Demographics
NPI:1639448483
Name:PATHWAYS COUNSELING CENTER, LLC
Entity Type:Organization
Organization Name:PATHWAYS COUNSELING CENTER, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CO-OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:GAIL
Authorized Official - Middle Name:E
Authorized Official - Last Name:O'NEILL
Authorized Official - Suffix:
Authorized Official - Credentials:LMHC
Authorized Official - Phone:321-622-6710
Mailing Address - Street 1:2525 AURORA RD
Mailing Address - Street 2:SUITE 104
Mailing Address - City:MELBOURNE
Mailing Address - State:FL
Mailing Address - Zip Code:32935-2833
Mailing Address - Country:US
Mailing Address - Phone:321-622-6710
Mailing Address - Fax:321-622-6715
Practice Address - Street 1:2525 AURORA RD
Practice Address - Street 2:SUITE 104
Practice Address - City:MELBOURNE
Practice Address - State:FL
Practice Address - Zip Code:32935-2833
Practice Address - Country:US
Practice Address - Phone:321-622-6710
Practice Address - Fax:321-622-6715
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-12-23
Last Update Date:2011-12-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL4695101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty