| Pride Pathways Program | |
|
770 S Grand Ave Apt 2062 Los Angeles CA 90017-3931 | |
| (310) 602-7586 | |
| Not Available |
| Full Name | Pride Pathways Program |
|---|---|
| Speciality | Community/behavioral Health |
| Location | 770 S Grand Ave Apt 2062, Los Angeles, California |
| Authorized Official Name and Position | Brenton Lipscomb (CHAIR PERSON) |
| Authorized Official Contact | 2563459006 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Pride Pathways Program 3705 W Pico Blvd # 967 Los Angeles CA 90019-3451 Ph: (323) 200-9602 | Pride Pathways Program 770 S Grand Ave Apt 2062 Los Angeles CA 90017-3931 Ph: (310) 602-7586 |
| NPI Number | 1023870094 |
|---|---|
| Provider Enumeration Date | 01/25/2024 |
| Last Update Date | 03/15/2024 |
| Certification Date | 03/15/2024 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1023870094 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 101YM0800X | Counselor - Mental Health | (* (Not Available)) | Secondary |
| 251S00000X | Community/behavioral Health | (* (Not Available)) | Primary |
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