| Pathways LLC | |
|
1301b Harrison Ave Mccomb MS 39648-2829 | |
| (601) 600-2429 | |
| (601) 600-2428 |
| Full Name | Pathways LLC |
|---|---|
| Speciality | Social Worker |
| Location | 1301b Harrison Ave, Mccomb, Mississippi |
| Authorized Official Name and Position | Bente Hess Johnson (SOLE MEMBER) |
| Authorized Official Contact | 6016002429 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Pathways LLC 2184 Old Liberty Rd Mccomb MS 39648-9123 Ph: (601) 600-2429 | Pathways LLC 1301b Harrison Ave Mccomb MS 39648-2829 Ph: (601) 600-2429 |
| NPI Number | 1104287937 |
|---|---|
| Provider Enumeration Date | 03/07/2016 |
| Last Update Date | 03/07/2016 |
| Medicare PECOS PAC ID | 9133401797 |
|---|---|
| Medicare Enrollment ID | O20170117001205 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1104287937 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1041C0700X | Social Worker - Clinical | C4173 (Mississippi) | Primary |
| 235Z00000X | Speech-language Pathologist | () | Secondary |
| 103K00000X | Behavior Analyst | () | Secondary |
| Provider Name | Bente Johnson |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1023479854 PECOS PAC ID: 0042592602 Enrollment ID: I20170117001520 |
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