Provider Demographics
NPI:1043690555
Name:COGNITIVE PATHWAYS
Entity type:Organization
Organization Name:COGNITIVE PATHWAYS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR / MENTAL HEALTH THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:R
Authorized Official - Last Name:STIVER
Authorized Official - Suffix:
Authorized Official - Credentials:LCPC
Authorized Official - Phone:224-733-1615
Mailing Address - Street 1:2504 WASHINGTON ST
Mailing Address - Street 2:SUITE 403
Mailing Address - City:WAUKEGAN
Mailing Address - State:IL
Mailing Address - Zip Code:60085-4983
Mailing Address - Country:US
Mailing Address - Phone:224-733-1615
Mailing Address - Fax:224-733-1620
Practice Address - Street 1:2504 WASHINGTON ST
Practice Address - Street 2:SUITE 403
Practice Address - City:WAUKEGAN
Practice Address - State:IL
Practice Address - Zip Code:60085-4983
Practice Address - Country:US
Practice Address - Phone:224-733-1615
Practice Address - Fax:224-733-1620
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-06-01
Last Update Date:2015-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL180008203251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health