Provider Demographics
NPI:1316500713
Name:HEALING PATHWAYS CENTER FOR PSYCHOTHERAPY & MINDFULNESS, PLLC
Entity type:Organization
Organization Name:HEALING PATHWAYS CENTER FOR PSYCHOTHERAPY & MINDFULNESS, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/CLINICAN
Authorized Official - Prefix:
Authorized Official - First Name:JENNIFER
Authorized Official - Middle Name:DIANE
Authorized Official - Last Name:MARSHALL
Authorized Official - Suffix:
Authorized Official - Credentials:LMSW
Authorized Official - Phone:810-206-1077
Mailing Address - Street 1:8123 GRAND RIVER RD STE 4
Mailing Address - Street 2:
Mailing Address - City:BRIGHTON
Mailing Address - State:MI
Mailing Address - Zip Code:48114-9464
Mailing Address - Country:US
Mailing Address - Phone:810-206-1077
Mailing Address - Fax:810-821-0877
Practice Address - Street 1:8123 GRAND RIVER RD STE D
Practice Address - Street 2:
Practice Address - City:BRIGHTON
Practice Address - State:MI
Practice Address - Zip Code:48114-9464
Practice Address - Country:US
Practice Address - Phone:734-646-2248
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-04-21
Last Update Date:2021-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty