Provider Demographics
NPI:1982378436
Name:PATHWAY MENTAL HEALTH
Entity Type:Organization
Organization Name:PATHWAY MENTAL HEALTH
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:CANDACE
Authorized Official - Middle Name:
Authorized Official - Last Name:HACK
Authorized Official - Suffix:
Authorized Official - Credentials:PMHNP
Authorized Official - Phone:270-245-2413
Mailing Address - Street 1:1400 ELVA RD
Mailing Address - Street 2:
Mailing Address - City:MADISONVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:42431-7840
Mailing Address - Country:US
Mailing Address - Phone:270-875-3729
Mailing Address - Fax:
Practice Address - Street 1:11 MCLEOD LN
Practice Address - Street 2:
Practice Address - City:MADISONVILLE
Practice Address - State:KY
Practice Address - Zip Code:42431-3650
Practice Address - Country:US
Practice Address - Phone:270-875-3729
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-08-06
Last Update Date:2022-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)Group - Multi-Specialty
No363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Multi-Specialty