Provider Demographics
NPI:1073300554
Name:PATHWAY PARTNERS YOUTH AND DEVELOPMENT SERVICES
Entity type:Organization
Organization Name:PATHWAY PARTNERS YOUTH AND DEVELOPMENT SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:CAMERON
Authorized Official - Middle Name:
Authorized Official - Last Name:WHITE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:765-617-6031
Mailing Address - Street 1:5905 COQUINA KEY DR APT F
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46224-8085
Mailing Address - Country:US
Mailing Address - Phone:765-617-6031
Mailing Address - Fax:
Practice Address - Street 1:5905 COQUINA KEY DR APT F
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46224-8085
Practice Address - Country:US
Practice Address - Phone:765-617-6031
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-04-21
Last Update Date:2025-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0855XAmbulatory Health Care FacilitiesClinic/CenterAdolescent and Children Mental Health