Provider Demographics
NPI:1861818122
Name:PATHWAY TO PEACE NFP
Entity Type:Organization
Organization Name:PATHWAY TO PEACE NFP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:THERAPIST
Authorized Official - Prefix:DR
Authorized Official - First Name:LINDORIA
Authorized Official - Middle Name:C
Authorized Official - Last Name:STOREY
Authorized Official - Suffix:
Authorized Official - Credentials:MSW, LCSW,PHD
Authorized Official - Phone:312-898-7358
Mailing Address - Street 1:23831 S KURT LN
Mailing Address - Street 2:
Mailing Address - City:CRETE
Mailing Address - State:IL
Mailing Address - Zip Code:60417-1737
Mailing Address - Country:US
Mailing Address - Phone:312-898-7358
Mailing Address - Fax:312-444-0793
Practice Address - Street 1:9510 S CONSTANCE AVE STE C-6
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60617-4700
Practice Address - Country:US
Practice Address - Phone:312-898-7358
Practice Address - Fax:312-444-0793
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-03-11
Last Update Date:2019-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
1041C0700X
IL149.016943251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes251S00000XAgenciesCommunity/Behavioral Health
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL32264879201Medicaid