Provider Demographics
NPI:1952789281
Name:PATHWAYS NORTHWEST COUNSELING SERVICE
Entity Type:Organization
Organization Name:PATHWAYS NORTHWEST COUNSELING SERVICE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MANNY
Authorized Official - Middle Name:
Authorized Official - Last Name:CRUZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:541-944-1247
Mailing Address - Street 1:611 SISKIYOU BLVD
Mailing Address - Street 2:SUITE 8
Mailing Address - City:ASHLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97520-2151
Mailing Address - Country:US
Mailing Address - Phone:541-944-1247
Mailing Address - Fax:
Practice Address - Street 1:2364 MAIN ST
Practice Address - Street 2:SUITE A
Practice Address - City:PHILOMATH
Practice Address - State:OR
Practice Address - Zip Code:97370-9488
Practice Address - Country:US
Practice Address - Phone:541-944-1247
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-05-06
Last Update Date:2015-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Single Specialty