Provider Demographics
NPI:1851531321
Name:PATHWAYS THERAPY CENTER
Entity Type:Organization
Organization Name:PATHWAYS THERAPY CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINICAL DIRECTOR/OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:SALLY
Authorized Official - Middle Name:ANNE
Authorized Official - Last Name:FITTS
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:916-979-0964
Mailing Address - Street 1:9700 FAIR OAKS BLVD STE G
Mailing Address - Street 2:
Mailing Address - City:FAIR OAKS
Mailing Address - State:CA
Mailing Address - Zip Code:95628-7079
Mailing Address - Country:US
Mailing Address - Phone:916-979-0964
Mailing Address - Fax:916-962-1940
Practice Address - Street 1:9700 FAIR OAKS BLVD STE G
Practice Address - Street 2:
Practice Address - City:FAIR OAKS
Practice Address - State:CA
Practice Address - Zip Code:95628-7079
Practice Address - Country:US
Practice Address - Phone:916-979-0964
Practice Address - Fax:916-962-1940
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-02-24
Last Update Date:2009-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA192761041C0700X
CA44220106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty
No106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1962660811OtherINDIVIDUAL NPI