Provider Demographics
NPI:1689986861
Name:EXPRESSIVE PATHWAYS, LLC
Entity Type:Organization
Organization Name:EXPRESSIVE PATHWAYS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO, OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ASHLEIGH
Authorized Official - Middle Name:MAE BREWER
Authorized Official - Last Name:SHAFFER
Authorized Official - Suffix:
Authorized Official - Credentials:MMT, LBS, BCBA
Authorized Official - Phone:223-797-1485
Mailing Address - Street 1:7540 ALLENTOWN BLVD
Mailing Address - Street 2:UNIT 5
Mailing Address - City:HARRISBURG
Mailing Address - State:PA
Mailing Address - Zip Code:17112-4237
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:7540 ALLENTOWN BLVD
Practice Address - Street 2:UNIT 5
Practice Address - City:HARRISBURG
Practice Address - State:PA
Practice Address - Zip Code:17112-4237
Practice Address - Country:US
Practice Address - Phone:717-919-8022
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-07-05
Last Update Date:2022-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA1-10-6973103K00000X
251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes251S00000XAgenciesCommunity/Behavioral HealthGroup - Multi-Specialty
No103K00000XBehavioral Health & Social Service ProvidersBehavior AnalystGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA103861580-0001Medicaid