Provider Demographics
NPI:1912021874
Name:PATHWAYS PSYCHOLOGICAL SERVICES, PA
Entity Type:Organization
Organization Name:PATHWAYS PSYCHOLOGICAL SERVICES, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MARCIA
Authorized Official - Middle Name:L
Authorized Official - Last Name:MCCOY
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:316-322-9500
Mailing Address - Street 1:PO BOX 606
Mailing Address - Street 2:
Mailing Address - City:EL DORADO
Mailing Address - State:KS
Mailing Address - Zip Code:67042-0606
Mailing Address - Country:US
Mailing Address - Phone:316-322-9500
Mailing Address - Fax:316-322-9500
Practice Address - Street 1:100 S MAIN ST
Practice Address - Street 2:SUITE 205
Practice Address - City:EL DORADO
Practice Address - State:KS
Practice Address - Zip Code:67042-3402
Practice Address - Country:US
Practice Address - Phone:316-322-9500
Practice Address - Fax:316-322-9500
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-18
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS957103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS4716OtherPREFERRED HEALTH SYSTEMS
KS4716OtherPREFERRED HEALTH SYSTEMS
KS=========OtherFISERV HEALTH - KANSAS