Provider Demographics
NPI:1598512071
Name:PATHWAY TO WELLNESS COUNSELING, LLC.
Entity type:Organization
Organization Name:PATHWAY TO WELLNESS COUNSELING, LLC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/BEHAVIORAL HEALTH CLINICIAN
Authorized Official - Prefix:
Authorized Official - First Name:ALYSIA
Authorized Official - Middle Name:MK
Authorized Official - Last Name:SMITH
Authorized Official - Suffix:
Authorized Official - Credentials:LPC
Authorized Official - Phone:715-416-1451
Mailing Address - Street 1:N11499 MCCLAIN LAKE RD
Mailing Address - Street 2:
Mailing Address - City:TREGO
Mailing Address - State:WI
Mailing Address - Zip Code:54888-9142
Mailing Address - Country:US
Mailing Address - Phone:715-416-1451
Mailing Address - Fax:
Practice Address - Street 1:N11499 MCCLAIN LAKE RD
Practice Address - Street 2:
Practice Address - City:TREGO
Practice Address - State:WI
Practice Address - Zip Code:54888-9142
Practice Address - Country:US
Practice Address - Phone:715-416-5414
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-05-02
Last Update Date:2024-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI100091376Medicaid