Provider Demographics
NPI:1174385942
Name:PATHWAYS TO POTENTIAL
Entity type:Organization
Organization Name:PATHWAYS TO POTENTIAL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER, BCBA
Authorized Official - Prefix:
Authorized Official - First Name:JENNY
Authorized Official - Middle Name:LYNN GALAMAGA
Authorized Official - Last Name:PAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:586-209-3683
Mailing Address - Street 1:53869 CONNOR DR
Mailing Address - Street 2:
Mailing Address - City:CHESTERFIELD
Mailing Address - State:MI
Mailing Address - Zip Code:48051-3930
Mailing Address - Country:US
Mailing Address - Phone:586-209-3683
Mailing Address - Fax:
Practice Address - Street 1:53869 CONNOR DR
Practice Address - Street 2:
Practice Address - City:CHESTERFIELD
Practice Address - State:MI
Practice Address - Zip Code:48051-3930
Practice Address - Country:US
Practice Address - Phone:586-209-3683
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-01-26
Last Update Date:2024-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior AnalystGroup - Single Specialty