Provider Demographics
NPI: | 1013778034 |
---|---|
Name: | PATHWAYS MENTAL HEALTH SERVICES LLC |
Entity Type: | Organization |
Organization Name: | PATHWAYS MENTAL HEALTH SERVICES LLC |
Other - Org Name: | |
Other - Org Type: | |
Authorized Official - Title/Position: | OWNER AND PMHNP |
Authorized Official - Prefix: | |
Authorized Official - First Name: | CRYSTAL |
Authorized Official - Middle Name: | |
Authorized Official - Last Name: | LANE |
Authorized Official - Suffix: | |
Authorized Official - Credentials: | MSN, APRN, PMHNP-BC |
Authorized Official - Phone: | 865-322-1953 |
Mailing Address - Street 1: | 7467 ARMORY RD |
Mailing Address - Street 2: | |
Mailing Address - City: | NEWPORT |
Mailing Address - State: | TN |
Mailing Address - Zip Code: | 37821-6781 |
Mailing Address - Country: | US |
Mailing Address - Phone: | 865-322-1953 |
Mailing Address - Fax: | |
Practice Address - Street 1: | 223 MINERAL ST |
Practice Address - Street 2: | |
Practice Address - City: | NEWPORT |
Practice Address - State: | TN |
Practice Address - Zip Code: | 37821-3827 |
Practice Address - Country: | US |
Practice Address - Phone: | 423-226-5431 |
Practice Address - Fax: | |
EIN: | <UNAVAIL> |
Is Organization Subpart?: | No |
Parent Organization LBN: | |
Parent Organization TIN: | |
Enumeration Date: | 2024-01-17 |
Last Update Date: | 2024-01-17 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization | Group |
---|---|---|---|---|---|
Yes | 363LP0808X | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Psychiatric/Mental Health | Group - Single Specialty |