Provider Demographics
NPI:1073313946
Name:RESILIENT PATHWAYS THERAPY CENTER
Entity type:Organization
Organization Name:RESILIENT PATHWAYS THERAPY CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:AQUA
Authorized Official - Middle Name:
Authorized Official - Last Name:STEFANO
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:858-352-8840
Mailing Address - Street 1:629 W MAIN ST STE 196
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73102-2221
Mailing Address - Country:US
Mailing Address - Phone:858-352-8840
Mailing Address - Fax:
Practice Address - Street 1:1006 NW 47TH ST STE B
Practice Address - Street 2:
Practice Address - City:LAWTON
Practice Address - State:OK
Practice Address - Zip Code:73505-4759
Practice Address - Country:US
Practice Address - Phone:858-352-8840
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-03-18
Last Update Date:2025-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty
No261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)Group - Single Specialty