| Organization Name: | PATHWAY TO WELLNESS COMMUNITY CLINIC LLC |
| NPI Number: | 1528413739 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | TAMMY M KIRCH (OWNER) |
| Mailing Address: | 560 4th St Prairie Du Sac |
| State: | WI US |
| Postal Code: | 535781136 |
| Phone Number: | 6083708131 |
| Fax Number: | 6086435014 |
| NPI Enumeration Date: | 04/26/2016 |
| NPI Last Update Date: | 04/26/2016 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 101YM0800X |
| License Number: | |
| Healthcare Provider Taxonomy: (Secondary) | N |
| State: | |
| Taxonomy Type: | Behavioral Health & Social Service Providers |
| Taxonomy Classification: | Counselor |
| Taxonomy Specialization: | Mental Health |
| Taxonomy Definition: | |