Provider Demographics
NPI:1811881345
Name:PATH TO MENTAL HEALTH WELLNESS LLC
Entity type:Organization
Organization Name:PATH TO MENTAL HEALTH WELLNESS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PMHNP
Authorized Official - Prefix:
Authorized Official - First Name:SOUAD
Authorized Official - Middle Name:
Authorized Official - Last Name:ALFARAJ
Authorized Official - Suffix:
Authorized Official - Credentials:NP
Authorized Official - Phone:616-617-3905
Mailing Address - Street 1:12116 ROMEO LN
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:MI
Mailing Address - Zip Code:48094-3195
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:12116 ROMEO LN
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:MI
Practice Address - Zip Code:48094-3195
Practice Address - Country:US
Practice Address - Phone:616-617-3905
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-06-09
Last Update Date:2025-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Single Specialty