Provider Demographics
NPI:1356779706
Name:THE SHEPHERDS NEW PATHWAYS, LLC
Entity type:Organization
Organization Name:THE SHEPHERDS NEW PATHWAYS, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:CHARLES
Authorized Official - Middle Name:
Authorized Official - Last Name:THIELEPAPE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:254-228-5830
Mailing Address - Street 1:5293 S 31ST ST STE 137
Mailing Address - Street 2:
Mailing Address - City:TEMPLE
Mailing Address - State:TX
Mailing Address - Zip Code:76502-3575
Mailing Address - Country:US
Mailing Address - Phone:254-228-5830
Mailing Address - Fax:254-598-2537
Practice Address - Street 1:5293 S 31ST ST STE 137
Practice Address - Street 2:
Practice Address - City:TEMPLE
Practice Address - State:TX
Practice Address - Zip Code:76502-3575
Practice Address - Country:US
Practice Address - Phone:254-228-5830
Practice Address - Fax:254-598-2537
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-10-22
Last Update Date:2021-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX69113101YM0800X
TX67305101YM0800X
TX201697106H00000X
101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Multi-Specialty
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty
No106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1356779706OtherNPI
TX409273601Medicaid