Provider Demographics
NPI:1871992206
Name:PATHWAYS BEHAVIORAL HEALTH CARE
Entity type:Organization
Organization Name:PATHWAYS BEHAVIORAL HEALTH CARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BILLING CLERK
Authorized Official - Prefix:
Authorized Official - First Name:BRANDY
Authorized Official - Middle Name:
Authorized Official - Last Name:FULLER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:660-890-8076
Mailing Address - Street 1:211 J ST APT C1
Mailing Address - Street 2:
Mailing Address - City:CREIGHTON
Mailing Address - State:MO
Mailing Address - Zip Code:64739-9771
Mailing Address - Country:US
Mailing Address - Phone:816-372-2652
Mailing Address - Fax:
Practice Address - Street 1:1010 REMINGTON PLZ
Practice Address - Street 2:
Practice Address - City:RAYMORE
Practice Address - State:MO
Practice Address - Zip Code:64083-8640
Practice Address - Country:US
Practice Address - Phone:816-318-4430
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-08-21
Last Update Date:2014-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2000165271261QM0855X, 302R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0855XAmbulatory Health Care FacilitiesClinic/CenterAdolescent and Children Mental Health
No302R00000XManaged Care OrganizationsHealth Maintenance Organization