Provider Demographics
NPI:1265977557
Name:PATHWAYS HUMAN SERVICES, LLC
Entity type:Organization
Organization Name:PATHWAYS HUMAN SERVICES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:STATE DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:SCOTT
Authorized Official - Last Name:WALLACE
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:512-343-8606
Mailing Address - Street 1:1524 S IH 35
Mailing Address - Street 2:SUITE 210
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78704-8931
Mailing Address - Country:US
Mailing Address - Phone:512-343-8606
Mailing Address - Fax:
Practice Address - Street 1:610 GOLD AVE SW
Practice Address - Street 2:SUITE 236
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87102-3146
Practice Address - Country:US
Practice Address - Phone:505-998-0422
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-12-22
Last Update Date:2016-12-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM1044101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Single Specialty