Provider Demographics
NPI:1427420744
Name:PATHWAYS THERAPEUTIC SERVICES, LLC
Entity type:Organization
Organization Name:PATHWAYS THERAPEUTIC SERVICES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:SHANNON
Authorized Official - Middle Name:P
Authorized Official - Last Name:REINER
Authorized Official - Suffix:
Authorized Official - Credentials:MSW/LICSW
Authorized Official - Phone:320-221-4051
Mailing Address - Street 1:PO BOX 191
Mailing Address - Street 2:
Mailing Address - City:LITCHFIELD
Mailing Address - State:MN
Mailing Address - Zip Code:55355-0191
Mailing Address - Country:US
Mailing Address - Phone:320-221-4051
Mailing Address - Fax:
Practice Address - Street 1:621 SIBLEY AVE SOUTH
Practice Address - Street 2:
Practice Address - City:LITCHFIELD
Practice Address - State:MN
Practice Address - Zip Code:55355
Practice Address - Country:US
Practice Address - Phone:320-221-4051
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-10-26
Last Update Date:2015-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN124891041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty