Provider Demographics
NPI:1720779093
Name:PATH TO TRANSFORMATION LLC
Entity type:Organization
Organization Name:PATH TO TRANSFORMATION LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ALEXIS
Authorized Official - Middle Name:
Authorized Official - Last Name:CROOK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:502-322-7071
Mailing Address - Street 1:16802 POLO FIELDS LN
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40245-4456
Mailing Address - Country:US
Mailing Address - Phone:502-322-7071
Mailing Address - Fax:
Practice Address - Street 1:271 W SHORT ST STE 410
Practice Address - Street 2:
Practice Address - City:LEXINGTON
Practice Address - State:KY
Practice Address - Zip Code:40507-1213
Practice Address - Country:US
Practice Address - Phone:502-322-7071
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-05-17
Last Update Date:2023-05-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)