Provider Demographics
NPI:1730613894
Name:PATHWISE COUNSELING AND SKILLS CENTER
Entity type:Organization
Organization Name:PATHWISE COUNSELING AND SKILLS CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/CLINICIAN
Authorized Official - Prefix:
Authorized Official - First Name:MELISSA
Authorized Official - Middle Name:MARIS FOUNTAIN
Authorized Official - Last Name:JENNINGS
Authorized Official - Suffix:
Authorized Official - Credentials:MA MCJ LPC LAC
Authorized Official - Phone:720-355-4082
Mailing Address - Street 1:992 S 4TH AVE STE 100-149
Mailing Address - Street 2:
Mailing Address - City:BRIGHTON
Mailing Address - State:CO
Mailing Address - Zip Code:80601-6802
Mailing Address - Country:US
Mailing Address - Phone:720-355-4082
Mailing Address - Fax:
Practice Address - Street 1:806 S PUBLIC RD STE 101
Practice Address - Street 2:
Practice Address - City:LAFAYETTE
Practice Address - State:CO
Practice Address - Zip Code:80026-2198
Practice Address - Country:US
Practice Address - Phone:720-355-4082
Practice Address - Fax:720-302-2671
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-04-16
Last Update Date:2024-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO4125101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Single Specialty