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Organization
PATHWAYS AUTISM CENTER LLC
Active
Organization
PATHWAYS AUTISM CENTER LLC
Active
Other names
PATHWAYS AUTISM CENTER LLC
Organization subpart
No
Provider details
NPI number
Authorized official
IBRAHIM ABUMUNYE (CEO)
(612) 481-0934
Entity
Organization
Contact information
Practice address
2021 E HENNEPIN AVE STE 155, MINNEAPOLIS, MN 55413-1772
(612) 481-0934
Mailing address
1738 NEWBRIGHTON BLVD, SUITE 104-223, MINNEAPOLIS, MN 55413
(612) 481-0934
Taxonomy
Speciality
Code
Description
License number
State
2084P0804X
Child & Adolescent Psychiatry Physician
—
—
261QM0855X
Adolescent and Children Mental Health Clinic/Center
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
01
—
MN
Enumeration date
10/31/2019
Last updated
10/31/2019
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