Provider Demographics
NPI:1013287770
Name:PATHWAY CHURCH
Entity Type:Organization
Organization Name:PATHWAY CHURCH
Other - Org Name:WESTLINK CHRISTIAN CHURCH
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:COORDINATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:ERIC
Authorized Official - Middle Name:J
Authorized Official - Last Name:PARKS
Authorized Official - Suffix:
Authorized Official - Credentials:LCMFT
Authorized Official - Phone:316-722-8020
Mailing Address - Street 1:2001 N MAIZE RD
Mailing Address - Street 2:
Mailing Address - City:WICHITA
Mailing Address - State:KS
Mailing Address - Zip Code:67212-5205
Mailing Address - Country:US
Mailing Address - Phone:316-722-8020
Mailing Address - Fax:316-722-4297
Practice Address - Street 1:2001 N MAIZE RD
Practice Address - Street 2:
Practice Address - City:WICHITA
Practice Address - State:KS
Practice Address - Zip Code:67212-5205
Practice Address - Country:US
Practice Address - Phone:316-722-8020
Practice Address - Fax:316-722-4297
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-01-11
Last Update Date:2016-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KSLCMFT904106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Single Specialty