Provider Demographics
NPI:1386096733
Name:PATHWAYS MI ALLEGAN
Entity type:Organization
Organization Name:PATHWAYS MI ALLEGAN
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:
Authorized Official - First Name:MARIE
Authorized Official - Middle Name:
Authorized Official - Last Name:BRILL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:616-396-2301
Mailing Address - Street 1:213 HUBBARD ST
Mailing Address - Street 2:
Mailing Address - City:ALLEGAN
Mailing Address - State:MI
Mailing Address - Zip Code:49010-1320
Mailing Address - Country:US
Mailing Address - Phone:269-673-1896
Mailing Address - Fax:269-686-2011
Practice Address - Street 1:213 HUBBARD ST
Practice Address - Street 2:
Practice Address - City:ALLEGAN
Practice Address - State:MI
Practice Address - Zip Code:49010-1320
Practice Address - Country:US
Practice Address - Phone:269-673-1896
Practice Address - Fax:269-686-2011
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:PATHWAYS MI
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2016-07-11
Last Update Date:2016-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MISA0030024101YA0400X
101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Multi-Specialty
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty