Provider Demographics
NPI:1811484603
Name:PATH TO AWARENESS PC
Entity type:Organization
Organization Name:PATH TO AWARENESS PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRACTICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:FAITH
Authorized Official - Middle Name:
Authorized Official - Last Name:BROWN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:541-323-8705
Mailing Address - Street 1:2239 NE DOCTORS DR STE 110
Mailing Address - Street 2:
Mailing Address - City:BEND
Mailing Address - State:OR
Mailing Address - Zip Code:97701-7185
Mailing Address - Country:US
Mailing Address - Phone:541-323-8705
Mailing Address - Fax:541-323-8707
Practice Address - Street 1:2239 NE DOCTORS DR STE 110
Practice Address - Street 2:
Practice Address - City:BEND
Practice Address - State:OR
Practice Address - Zip Code:97701-7185
Practice Address - Country:US
Practice Address - Phone:541-323-8705
Practice Address - Fax:541-323-8708
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-04-17
Last Update Date:2023-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORMD285682084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Single Specialty