Provider Demographics
NPI:1992334221
Name:KREATING YOUR PATH FIRM LLC
Entity type:Organization
Organization Name:KREATING YOUR PATH FIRM LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO, OWER
Authorized Official - Prefix:
Authorized Official - First Name:JOHNECE
Authorized Official - Middle Name:M
Authorized Official - Last Name:SMITH
Authorized Official - Suffix:
Authorized Official - Credentials:LPC, NCC
Authorized Official - Phone:205-643-5644
Mailing Address - Street 1:429 GREEN SPRINGS HWY STE 161
Mailing Address - Street 2:
Mailing Address - City:BIRMINGHAM
Mailing Address - State:AL
Mailing Address - Zip Code:35209-4938
Mailing Address - Country:US
Mailing Address - Phone:206-642-5644
Mailing Address - Fax:
Practice Address - Street 1:2100A SOUTHBRIDGE PKWY STE 650
Practice Address - Street 2:
Practice Address - City:BIRMINGHAM
Practice Address - State:AL
Practice Address - Zip Code:35209-1377
Practice Address - Country:US
Practice Address - Phone:205-440-2685
Practice Address - Fax:833-289-6535
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-04-07
Last Update Date:2023-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Multi-Specialty
No261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)
No261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health
No261QM0855XAmbulatory Health Care FacilitiesClinic/CenterAdolescent and Children Mental HealthGroup - Multi-Specialty