| NPI | 1043228505 |
|---|---|
| Former Legal Business Name | PATHWAY CLINIC, SC |
| Entity Type | Organization |
| Authorized Contact | THEODORE WELTZIN Co Owner 414-727-4455 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QM0801X Clinic/Center, Mental Health (Including Community Mental Health Center) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: WI 1729) |
| 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: WI 1729) | |
| Enumeration Date | 2006-08-03 |
| Last Update Date | 2017-04-18 |