PATHWAYS MENTAL HEALTH SERVICES (NPI# 1306004775) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1306004775 |
| Entity Type | Organization |
| Organization Name | PATHWAYS MENTAL HEALTH SERVICES |
| Practice Address |
4804 Lacey Blvd Se Ste A Suite C-3 Lacey WA 98503-5733 |
| Mailing Address |
4804 Lacey Blvd Se Ste A Lacey WA 98503-5733 |
| Practice Telephone | 3607995782 |
| Practice Fax Number | 3605391715 |
| Mailing Telephone | 3607995782 |
| Mailing Fax Number | 3605391715 |
| Enumeration Date | 2008-06-01 |
| Last Update Date | 2016-05-24 |
| Authorized Official Name | DR. ART TOLENTINO (CLINICAL DIRECTOR) |
| Authorized Official Telephone | 3607995782 |
| Authorized Official Credential | PHD |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| N | 261QM0801X |
Clinic/Center Specialization: Mental Health (Including Community Mental Health Center) |
LF00002685 | WA | Ambulatory Health Care Facilities |
| N | 261QR0405X |
Clinic/Center Specialization: Rehabilitation, Substance Use Disorder |
LF00002685 | WA | Ambulatory Health Care Facilities |
| Y | 101YM0800X |
Counselor Specialization: Mental Health |
Behavioral Health & Social Service Providers |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1497131247 | Pathways Mental Health Services | Community/Behavioral Health | 1230 Carpenter Rd Se # C-3se, Lacey, WA 98503-7219 | 2015-08-04 |
| Entity Type | Entity Name | Entity Address |
|---|---|---|
| Washington State Corporations | PATHWAYS MENTAL HEALTH SERVICES LLC | 4804 Lacey Blvd Se Ste A, Lacey, WA 98503-5733 |
| Street Address |
4804 LACEY BLVD SE STE A SUITE C-3 |
| City | LACEY |
| State | WA |
| Zip Code | 98503-5733 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1750916086 | Ozark Gore | Psychologist | 4804 Lacey Blvd Se Ste A, Lacey, WA 98503-5733 | 2020-03-06 |
| 1255970554 | Elaine Vaughn | Counselor | 4804 Lacey Blvd Se Ste A, Lacey, WA 98503-5733 | 2020-01-03 |
| 1649830647 | Jeremy Craig Bolden | Social Worker | 4804 Lacey Blvd Se Ste A, Lacey, WA 98503-5733 | 2019-06-20 |
| 1821555111 | Katherine Eleanor Parker | Marriage & Family Therapist | 4804 Lacey Blvd Se Ste A, Lacey, WA 98503-5733 | 2019-02-22 |
| 1053822502 | Megan E Plascencia | Counselor | 4804 Lacey Blvd Se Ste A, Lacey, WA 98503-5733 | 2017-10-23 |
| 1023441920 | Diana Carlson | Counselor | 4804 Lacey Blvd Se Ste A, Lacey, WA 98503-5733 | 2013-08-14 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1457838989 | Michele Nordgren Bourque | Psychologist | 4329 Concordia Lane Se, Lacey, WA 98503 | 2018-07-26 |
| 1831638675 | Trevor John Marum | Chiropractor | 3945 8th Ave Se, Lacey, WA 98503 | 2017-02-13 |
| 1366993362 | Vanessa Julie Iglesias Mehta | Physician Assistant | 5128 Yelm Hwy Se, Suite E, Lacey, WA 98503 | 2016-10-14 |
| 1144683616 | Millenda Thomas | Registered Nurse | 1233 Firpark Dr. S.e., Lacey, WA 98503 | 2016-04-01 |
| 1609257245 | Erika Charlotte Vonkotzebue | Counselor | 4401 37th Ave. Se #25, Lacey, WA 98503 | 2015-06-09 |
| 1437576196 | Candy Nelson | Registered Nurse | 4410 6th Ave Se, Apt# 115, Lacy, WA 98503 | 2014-03-19 |
| 1134563919 | Alvin Fitzgerald | Pharmacist | 665 Sleater Kinney Rd., S.e, Target Pharmacy #1355, Lacey, WA 98503 | 2013-04-23 |
| 1518200724 | Katherine Mary Marsh | Psychologist | 5191 Corporate Center Court Se, Lacey, WA 98503 | 2013-04-05 |
| 1740530906 | Leanna Marie Mcbroom | Massage Therapist | 1608 Diamond Loop Se, Lacey, WA 98503 | 2012-09-14 |
| 1831445196 | Joyce Emily Christensen Coniff | Counselor | 5706 39th Ave Se., Lacey, WA 98503 | 2012-07-24 |
| Find all providers in zip 98503 | ||||
| Taxonomy Code | 101YM0800X |
| Grouping | Behavioral Health & Social Service Providers |
| Classification | Counselor |
| Specialization | Mental Health |
| Definition to come... |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1467074609 | Krave Lyfe Mental Health Counseling | Counselor | 6326 Martin Way E Ste 200, Lacey, WA 98516-5570 | 2020-05-11 |
| 1760001630 | Robbion Jarado Harris | Counselor | 4104 Ingleside Dr Se, Lacey, WA 98503-2113 | 2020-04-10 |
| 1891286712 | Tracy J Downs | Counselor | 1138 Golf Club Rd Se Apt 101, Lacey, WA 98503-2395 | 2018-05-25 |
| 1578090015 | Heather Marie Rehaume | Counselor | 1219 Warner St Ne, Lacey, WA 98516-5427 | 2017-05-15 |
| 1609257245 | Erika Charlotte Vonkotzebue | Counselor | 4401 37th Ave. Se #25, Lacey, WA 98503 | 2015-06-09 |
| 1518347384 | Bonnie Margaret Edwards | Counselor | 6402 57th Ct Se, Lacey, WA 98513-4159 | 2015-06-05 |
| 1053709576 | Calvin Wynn | Counselor | 7819 48th Ave Se, Lacey, WA 98503-4609 | 2015-01-06 |
| 1154727279 | Douglas Gemmell | Counselor | 7054 Radius Loop Se, Lacey, WA 98513-5134 | 2014-11-17 |
| 1184040503 | Rebecca K Slosson | Counselor | 4313 6th Ave Se Ste C102, Lacey, WA 98503-1072 | 2014-03-10 |
| 1831445196 | Joyce Emily Christensen Coniff | Counselor | 5706 39th Ave Se., Lacey, WA 98503 | 2012-07-24 |
| Find all providers in LACEY | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.