Provider Demographics
NPI:1659328284
Name:COMMUNITY PATHWAYS UNLIMITED INC
Entity Type:Organization
Organization Name:COMMUNITY PATHWAYS UNLIMITED INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR OF OPERATINS
Authorized Official - Prefix:
Authorized Official - First Name:PAMELA
Authorized Official - Middle Name:KAY
Authorized Official - Last Name:DYER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:405-842-4911
Mailing Address - Street 1:4045 NW 64TH ST
Mailing Address - Street 2:STE 520
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73116-8608
Mailing Address - Country:US
Mailing Address - Phone:405-842-4911
Mailing Address - Fax:
Practice Address - Street 1:4045 NW 64TH ST
Practice Address - Street 2:STE 520
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73116-8608
Practice Address - Country:US
Practice Address - Phone:405-842-4911
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-28
Last Update Date:2022-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK260103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OKDD4662OtherRAILROAD MEDICARE
OK100744820AMedicaid
OK442366315001OtherOUTPT MENTAL HEALTH
OK442366315Medicare ID - Type UnspecifiedOUTPT MENTAL HEALTH
OK100744820AMedicaid