Provider Demographics
NPI:1659384824
Name:PATHWAY TO RECOVERY, INC.
Entity Type:Organization
Organization Name:PATHWAY TO RECOVERY, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO/PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:DENNIS
Authorized Official - Middle Name:L
Authorized Official - Last Name:MCCOLGIN
Authorized Official - Suffix:
Authorized Official - Credentials:LCDC
Authorized Official - Phone:409-933-4366
Mailing Address - Street 1:2119 OAK ST
Mailing Address - Street 2:
Mailing Address - City:LAMARQUE
Mailing Address - State:TX
Mailing Address - Zip Code:77568-4246
Mailing Address - Country:US
Mailing Address - Phone:409-933-4366
Mailing Address - Fax:409-933-4367
Practice Address - Street 1:2119 OAK ST
Practice Address - Street 2:
Practice Address - City:LA MARQUE
Practice Address - State:TX
Practice Address - Zip Code:77568-4246
Practice Address - Country:US
Practice Address - Phone:409-933-4366
Practice Address - Fax:409-933-4367
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-15
Last Update Date:2010-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1904-A101YA0400X, 324500000X
TX1904A324500000X
TX1904B324500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes324500000XResidential Treatment FacilitiesSubstance Abuse Rehabilitation Facility
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX556366OtherVALUE OPTIONS PROVIDER #
TX265402OtherCOMP PSYCH PROVIDER #
TXHH5101OtherBCBS PROVIDER NUMBER