Provider Demographics
NPI:1740380724
Name:PATHHEALER, LTD
Entity Type:Organization
Organization Name:PATHHEALER, LTD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MARY
Authorized Official - Middle Name:M
Authorized Official - Last Name:DESCH
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:602-393-2373
Mailing Address - Street 1:5025 N CENTRAL AVE
Mailing Address - Street 2:PMB 607
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85012-1520
Mailing Address - Country:US
Mailing Address - Phone:602-393-2373
Mailing Address - Fax:602-393-2374
Practice Address - Street 1:1037 E MISSOURI AVE
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85014-2663
Practice Address - Country:US
Practice Address - Phone:602-393-2373
Practice Address - Fax:602-393-2374
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-22
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Single Specialty