Provider Demographics
NPI:1104439397
Name:PATHWAY TO SERENITY
Entity type:Organization
Organization Name:PATHWAY TO SERENITY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO/OWNER OF LLC
Authorized Official - Prefix:
Authorized Official - First Name:SHELLEY
Authorized Official - Middle Name:
Authorized Official - Last Name:HORINE
Authorized Official - Suffix:
Authorized Official - Credentials:MA, LPCC
Authorized Official - Phone:567-280-0796
Mailing Address - Street 1:115 W FRONT ST UNIT 8
Mailing Address - Street 2:
Mailing Address - City:PERRYSBURG
Mailing Address - State:OH
Mailing Address - Zip Code:43551-1473
Mailing Address - Country:US
Mailing Address - Phone:567-280-0796
Mailing Address - Fax:
Practice Address - Street 1:115 W FRONT ST UNIT 8
Practice Address - Street 2:
Practice Address - City:PERRYSBURG
Practice Address - State:OH
Practice Address - Zip Code:43551-1473
Practice Address - Country:US
Practice Address - Phone:567-280-0796
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-08-26
Last Update Date:2020-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH1154735678OtherNPI