Provider Demographics
NPI:1316758071
Name:LUXE PATH BEHAVIORAL HEALTH & WELLNESS PLLC
Entity type:Organization
Organization Name:LUXE PATH BEHAVIORAL HEALTH & WELLNESS PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PROVIDER
Authorized Official - Prefix:
Authorized Official - First Name:TIMOTHY
Authorized Official - Middle Name:C
Authorized Official - Last Name:CLYNCH
Authorized Official - Suffix:
Authorized Official - Credentials:APRN, PMHNH-BC
Authorized Official - Phone:860-424-2623
Mailing Address - Street 1:27 MILL ST UNIT D
Mailing Address - Street 2:
Mailing Address - City:QUINCY
Mailing Address - State:MA
Mailing Address - Zip Code:02169-5656
Mailing Address - Country:US
Mailing Address - Phone:860-424-2623
Mailing Address - Fax:617-616-8095
Practice Address - Street 1:27 MILL ST UNIT D
Practice Address - Street 2:
Practice Address - City:QUINCY
Practice Address - State:MA
Practice Address - Zip Code:02169-5656
Practice Address - Country:US
Practice Address - Phone:860-424-2623
Practice Address - Fax:617-616-8095
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-01-14
Last Update Date:2025-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Multi-Specialty