Provider Demographics
NPI:1922338227
Name:FSL PATHWAYS
Entity Type:Organization
Organization Name:FSL PATHWAYS
Other - Org Name:AGL WATSON
Other - Org Type:Other Name
Authorized Official - Title/Position:EXECUTIVE ASSISTANT
Authorized Official - Prefix:
Authorized Official - First Name:ANNETTE
Authorized Official - Middle Name:
Authorized Official - Last Name:INIGUEZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:602-285-0505
Mailing Address - Street 1:1201 E THOMAS RD
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85014-5734
Mailing Address - Country:US
Mailing Address - Phone:602-285-0505
Mailing Address - Fax:602-285-1838
Practice Address - Street 1:916 E WATSON DR
Practice Address - Street 2:
Practice Address - City:TEMPE
Practice Address - State:AZ
Practice Address - Zip Code:85283-3031
Practice Address - Country:US
Practice Address - Phone:602-285-0505
Practice Address - Fax:602-285-1838
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-01-08
Last Update Date:2010-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZBHS3482251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZBHS3482OtherADHS - BEHAVIORAL