Provider Demographics
NPI:1699598235
Name:PROVEN PATHWAYS PSYCHOTHERAPY, LLC
Entity type:Organization
Organization Name:PROVEN PATHWAYS PSYCHOTHERAPY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINICAL PSYCHOLOGIST
Authorized Official - Prefix:DR
Authorized Official - First Name:LAREN
Authorized Official - Middle Name:
Authorized Official - Last Name:CONKLIN
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:614-594-9360
Mailing Address - Street 1:5151 REED RD STE 127C
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43220-2553
Mailing Address - Country:US
Mailing Address - Phone:614-594-9360
Mailing Address - Fax:
Practice Address - Street 1:5151 REED RD STE 127C
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43220-2553
Practice Address - Country:US
Practice Address - Phone:330-705-3748
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-11-04
Last Update Date:2024-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty