Provider Demographics
NPI:1992134902
Name:PATHWAYS TO INDEPENDENCE
Entity type:Organization
Organization Name:PATHWAYS TO INDEPENDENCE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CO OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:SALENCIA
Authorized Official - Middle Name:ELAINE
Authorized Official - Last Name:TALLEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:214-878-1080
Mailing Address - Street 1:4629 CHALK CT
Mailing Address - Street 2:
Mailing Address - City:GRAND PRAIRIE
Mailing Address - State:TX
Mailing Address - Zip Code:75052-1714
Mailing Address - Country:US
Mailing Address - Phone:214-878-1080
Mailing Address - Fax:972-522-0291
Practice Address - Street 1:4629 CHALK CT
Practice Address - Street 2:
Practice Address - City:GRAND PRAIRIE
Practice Address - State:TX
Practice Address - Zip Code:75052-1714
Practice Address - Country:US
Practice Address - Phone:214-878-1080
Practice Address - Fax:972-522-0291
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-11-11
Last Update Date:2013-11-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX251C00000X, 251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
No251C00000XAgenciesDay Training, Developmentally Disabled Services