Provider Demographics
NPI:1528684024
Name:PATH OF LIFE COUNSELING
Entity type:Organization
Organization Name:PATH OF LIFE COUNSELING
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:COLLEEN
Authorized Official - Middle Name:
Authorized Official - Last Name:ADARHORMAZD
Authorized Official - Suffix:
Authorized Official - Credentials:LPC
Authorized Official - Phone:541-207-8874
Mailing Address - Street 1:7075 NW APPALOOSA LN
Mailing Address - Street 2:
Mailing Address - City:CORVALLIS
Mailing Address - State:OR
Mailing Address - Zip Code:97330-9754
Mailing Address - Country:US
Mailing Address - Phone:541-207-8874
Mailing Address - Fax:
Practice Address - Street 1:685 NW 5TH ST STE A
Practice Address - Street 2:
Practice Address - City:CORVALLIS
Practice Address - State:OR
Practice Address - Zip Code:97330-6462
Practice Address - Country:US
Practice Address - Phone:541-234-7421
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-06-19
Last Update Date:2020-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health