Provider Demographics
NPI:1992124473
Name:HEALING PATHS, INC.
Entity type:Organization
Organization Name:HEALING PATHS, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:JAQUELINE
Authorized Official - Middle Name:
Authorized Official - Last Name:PACK
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:801-628-6344
Mailing Address - Street 1:1325 N MAIN ST
Mailing Address - Street 2:SUITE 3
Mailing Address - City:BOUNTIFUL
Mailing Address - State:UT
Mailing Address - Zip Code:84010-6089
Mailing Address - Country:US
Mailing Address - Phone:801-628-6344
Mailing Address - Fax:801-606-2703
Practice Address - Street 1:1325 N MAIN ST
Practice Address - Street 2:SUITE 3
Practice Address - City:BOUNTIFUL
Practice Address - State:UT
Practice Address - Zip Code:84010-6089
Practice Address - Country:US
Practice Address - Phone:801-628-6344
Practice Address - Fax:801-606-2703
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-04-10
Last Update Date:2014-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT31589135011041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty