Provider Demographics
NPI:1205272796
Name:PATHWAYS LIFE COACHING & SUPPORT SERVICE
Entity type:Organization
Organization Name:PATHWAYS LIFE COACHING & SUPPORT SERVICE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:SONIA
Authorized Official - Middle Name:
Authorized Official - Last Name:GUERAO
Authorized Official - Suffix:
Authorized Official - Credentials:LMHC
Authorized Official - Phone:321-749-6862
Mailing Address - Street 1:2060 HIGHWAY A1A
Mailing Address - Street 2:SUITE 304
Mailing Address - City:INDIAN HARBOUR BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32937-3596
Mailing Address - Country:US
Mailing Address - Phone:321-749-6862
Mailing Address - Fax:321-751-6734
Practice Address - Street 1:2060 HIGHWAY A1A
Practice Address - Street 2:SUITE 304
Practice Address - City:INDIAN HARBOUR BEACH
Practice Address - State:FL
Practice Address - Zip Code:32937-3596
Practice Address - Country:US
Practice Address - Phone:321-749-6862
Practice Address - Fax:321-751-6734
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-05-11
Last Update Date:2013-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL11161261QM0850X
FL11151261QM0855X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0855XAmbulatory Health Care FacilitiesClinic/CenterAdolescent and Children Mental Health
No261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL11161OtherDOH
FLVF=========300OtherVOCATIONAL REHABILITATION