Organization
ILLUMINATED PATHWAY LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
KATHERINE MICHELLE JACKSON LPC (DIRECTOR)
(253) 208-0756
Entity
Organization
Contact information
Practice address
17427 W WANDERING CREEK RD, GOODYEAR, AZ 85338-5735
(253) 208-0756
Mailing address
17427 W WANDERING CREEK RD, GOODYEAR, AZ 85338-5735
(253) 208-0756
Taxonomy
Speciality
Code
Description
License number
State
174200000X
Meals Provider
—
—
177F00000X
Lodging Provider
—
—
251B00000X
Case Management Agency
—
—
251C00000X
Developmentally Disabled Services Day Training Agency
—
—
251K00000X
Public Health or Welfare Agency
—
—
251S00000X
Community/Behavioral Health Agency
Primary
—
—
253J00000X
Foster Care Agency
—
—
253Z00000X
In Home Supportive Care Agency
—
—
Other
Enumeration date
01/13/2021
Last updated
07/11/2024
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