Provider Demographics
NPI:1396082087
Name:PATH TO HEALING, INC.
Entity type:Organization
Organization Name:PATH TO HEALING, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PRACTITIONER
Authorized Official - Prefix:MRS
Authorized Official - First Name:MELISSA
Authorized Official - Middle Name:A
Authorized Official - Last Name:GATES
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:815-288-1235
Mailing Address - Street 1:404 N GALENA AVE
Mailing Address - Street 2:SUITE L10
Mailing Address - City:DIXON
Mailing Address - State:IL
Mailing Address - Zip Code:61021-2115
Mailing Address - Country:US
Mailing Address - Phone:815-288-1235
Mailing Address - Fax:815-288-0034
Practice Address - Street 1:404 N GALENA AVE
Practice Address - Street 2:SUITE L10
Practice Address - City:DIXON
Practice Address - State:IL
Practice Address - Zip Code:61021-2115
Practice Address - Country:US
Practice Address - Phone:815-288-1235
Practice Address - Fax:815-288-0034
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-01-15
Last Update Date:2013-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL149010806251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health