Provider Demographics
NPI:1851596001
Name:CASCADE PATHWAYS, LLC
Entity Type:Organization
Organization Name:CASCADE PATHWAYS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:HAL
Authorized Official - Middle Name:CLIFFORD
Authorized Official - Last Name:DARST
Authorized Official - Suffix:
Authorized Official - Credentials:CADCII
Authorized Official - Phone:541-954-7077
Mailing Address - Street 1:344 NW 6TH ST
Mailing Address - Street 2:
Mailing Address - City:CORVALLIS
Mailing Address - State:OR
Mailing Address - Zip Code:97330-4814
Mailing Address - Country:US
Mailing Address - Phone:541-954-7077
Mailing Address - Fax:888-505-1903
Practice Address - Street 1:344 NW 6TH ST
Practice Address - Street 2:
Practice Address - City:CORVALLIS
Practice Address - State:OR
Practice Address - Zip Code:97330-4814
Practice Address - Country:US
Practice Address - Phone:541-954-7077
Practice Address - Fax:888-505-1903
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-18
Last Update Date:2015-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101Y00000X
OR99-11-61101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Multi-Specialty
No101Y00000XBehavioral Health & Social Service ProvidersCounselorGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR500664843Medicaid