Provider Demographics
NPI:1982773396
Name:PATHWAYS COMMUNITY SUPPORT OF TEXAS, INC.
Entity Type:Organization
Organization Name:PATHWAYS COMMUNITY SUPPORT OF TEXAS, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:STATE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:
Authorized Official - Last Name:WALLACE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:512-343-8606
Mailing Address - Street 1:1524 IH-35 SOUTH
Mailing Address - Street 2:SUITE 210
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78704
Mailing Address - Country:US
Mailing Address - Phone:512-343-8606
Mailing Address - Fax:512-343-8620
Practice Address - Street 1:1524 S IH-35
Practice Address - Street 2:SUITE 210
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78704
Practice Address - Country:US
Practice Address - Phone:512-343-8606
Practice Address - Fax:512-343-8620
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:PATHWAYS HEALTH AND COMMUNITY SERVICES, LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-11-07
Last Update Date:2016-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX152232801Medicaid
TX153227701Medicaid
TX155583101Medicaid