Provider Demographics
NPI:1215501705
Name:A CHOSEN PATH SOLUTIONS, LLC
Entity type:Organization
Organization Name:A CHOSEN PATH SOLUTIONS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINICAL DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:KENISHA
Authorized Official - Middle Name:
Authorized Official - Last Name:ROTIBI
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW-S
Authorized Official - Phone:972-890-6101
Mailing Address - Street 1:4683 BETTS DR STE 403
Mailing Address - Street 2:
Mailing Address - City:GRAND PRAIRIE
Mailing Address - State:TX
Mailing Address - Zip Code:75052-1807
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:4683 BETTS DR STE 403
Practice Address - Street 2:
Practice Address - City:GRAND PRAIRIE
Practice Address - State:TX
Practice Address - Zip Code:75052-1807
Practice Address - Country:US
Practice Address - Phone:972-890-6101
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:A CHOSEN PATH COUNSELING AND CONSULTING SERVICES, PLLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2021-05-18
Last Update Date:2021-05-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320900000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1679029136Medicaid