Provider Demographics
NPI:1881725919
Name:PATHOS, INC.
Entity type:Organization
Organization Name:PATHOS, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ART THERAPIST, LICENSED COUNSELOR
Authorized Official - Prefix:MISS
Authorized Official - First Name:LAURA
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:JACOB
Authorized Official - Suffix:
Authorized Official - Credentials:MAAT, LCPC
Authorized Official - Phone:773-562-1388
Mailing Address - Street 1:1700 W IRVING PARK RD
Mailing Address - Street 2:SUITE 108
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60613-2559
Mailing Address - Country:US
Mailing Address - Phone:773-562-1388
Mailing Address - Fax:773-435-1133
Practice Address - Street 1:1700 W IRVING PARK RD
Practice Address - Street 2:SUITE 108
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60613-2559
Practice Address - Country:US
Practice Address - Phone:773-562-1388
Practice Address - Fax:773-435-1133
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-08
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Single Specialty