Provider Demographics
NPI:1851495196
Name:PATHS OF CHANGE INC
Entity Type:Organization
Organization Name:PATHS OF CHANGE INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MS
Authorized Official - First Name:SHANON
Authorized Official - Middle Name:ELIZABETH
Authorized Official - Last Name:BRADEN
Authorized Official - Suffix:
Authorized Official - Credentials:PHD LPC
Authorized Official - Phone:918-336-1234
Mailing Address - Street 1:102 1/2 SW FRANK PHILLIPS
Mailing Address - Street 2:ROOM 4
Mailing Address - City:BARTLESVILLE
Mailing Address - State:OK
Mailing Address - Zip Code:74003
Mailing Address - Country:US
Mailing Address - Phone:918-336-1234
Mailing Address - Fax:918-336-7604
Practice Address - Street 1:102 1/2 SW FRANK PHILLIPS
Practice Address - Street 2:ROOM 4
Practice Address - City:BARTLESVILLE
Practice Address - State:OK
Practice Address - Zip Code:74003-6606
Practice Address - Country:US
Practice Address - Phone:918-336-1234
Practice Address - Fax:918-336-7604
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-08
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Single Specialty