Provider Demographics
NPI:1427322858
Name:PATHWAYS EARLY AUTISM INTERVENTION
Entity type:Organization
Organization Name:PATHWAYS EARLY AUTISM INTERVENTION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER / MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:MICHELLE
Authorized Official - Middle Name:D
Authorized Official - Last Name:CAMPBELL
Authorized Official - Suffix:
Authorized Official - Credentials:MS,CCC-SLP,BCBA
Authorized Official - Phone:817-408-8395
Mailing Address - Street 1:PO BOX 255
Mailing Address - Street 2:
Mailing Address - City:BLUFF DALE
Mailing Address - State:TX
Mailing Address - Zip Code:76433
Mailing Address - Country:US
Mailing Address - Phone:817-408-8395
Mailing Address - Fax:
Practice Address - Street 1:255 ANGLERS RIDGE
Practice Address - Street 2:
Practice Address - City:BLUFF DALE
Practice Address - State:TX
Practice Address - Zip Code:76433
Practice Address - Country:US
Practice Address - Phone:817-408-8395
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-03-02
Last Update Date:2012-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX14784101YP2500X
FL1095283103K00000X
FL1107216103K00000X
TX17279235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior AnalystGroup - Multi-Specialty
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Multi-Specialty
No235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Multi-Specialty