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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