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Organization
PATHWAYS EARLY AUTISM INTERVENTION
Active
Organization
PATHWAYS EARLY AUTISM INTERVENTION
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MICHELLE D CAMPBELL MS,CCC-SLP,BCBA (OWNER / MANAGER)
(817) 408-8395
Entity
Organization
Contact information
Practice address
255 ANGLERS RIDGE, BLUFF DALE, TX 76433
(817) 408-8395
Mailing address
PO BOX 255, BLUFF DALE, TX 76433
(817) 408-8395
Taxonomy
Speciality
Code
Description
License number
State
101YP2500X
Professional Counselor
14784
TX
103K00000X
Behavior Analyst
Primary
1095283
FL
103K00000X
Behavior Analyst
1107216
FL
235Z00000X
Speech-Language Pathologist
17279
TX
Other
Enumeration date
03/02/2012
Last updated
03/02/2012
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