Provider Demographics
NPI:1437742731
Name:PATHWAYS TO GROWTH PSYCHOTHERAPY LLC
Entity type:Organization
Organization Name:PATHWAYS TO GROWTH PSYCHOTHERAPY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER OF ENTITY
Authorized Official - Prefix:
Authorized Official - First Name:ANGELA
Authorized Official - Middle Name:L
Authorized Official - Last Name:EMERSON
Authorized Official - Suffix:
Authorized Official - Credentials:MSW, LISW
Authorized Official - Phone:515-979-8502
Mailing Address - Street 1:5601 TERRACE DR
Mailing Address - Street 2:
Mailing Address - City:JOHNSTON
Mailing Address - State:IA
Mailing Address - Zip Code:50131-1571
Mailing Address - Country:US
Mailing Address - Phone:515-979-8502
Mailing Address - Fax:
Practice Address - Street 1:5601 TERRACE DR
Practice Address - Street 2:
Practice Address - City:JOHNSTON
Practice Address - State:IA
Practice Address - Zip Code:50131-1571
Practice Address - Country:US
Practice Address - Phone:515-979-8502
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-02-17
Last Update Date:2021-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty