Provider Demographics
NPI:1861037087
Name:CARDINAL PATH WELLNESS LLC
Entity Type:Organization
Organization Name:CARDINAL PATH WELLNESS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING CLINICIAN
Authorized Official - Prefix:MS
Authorized Official - First Name:SARAH
Authorized Official - Middle Name:REBECCA
Authorized Official - Last Name:BALES
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:323-480-3710
Mailing Address - Street 1:PO BOX 1343
Mailing Address - Street 2:
Mailing Address - City:RATON
Mailing Address - State:NM
Mailing Address - Zip Code:87740-1343
Mailing Address - Country:US
Mailing Address - Phone:323-480-3710
Mailing Address - Fax:
Practice Address - Street 1:411 1/2 S 3RD ST
Practice Address - Street 2:
Practice Address - City:RATON
Practice Address - State:NM
Practice Address - Zip Code:87740-8774
Practice Address - Country:US
Practice Address - Phone:575-303-2260
Practice Address - Fax:575-303-4624
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-11-12
Last Update Date:2021-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)