Pathway Eclinic SC

Primary specialty

Mental Health CounselorTaxonomy code 101YM0800X

License

2605 Issued in WI

Legal business name

PATHWAY ECLINIC SC

Practice address

2300 N Mayfair Rd
Suite 425
Wauwatosa, WI 53226-1505

Phone

(414) 727-4455

Fax

(414) 727-4690

NPI assigned

Oct 14, 2008

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Tracey Lee Cornella- Carlson, MD

Title

Psychiatrist

Phone

(414) 727-4455

Specialties & licenses 1

Addresses

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Theodore Eldon Weltzin, MD

  • Psychiatry Physician
  • Wauwatosa, WI
  • NPI 1457343923
  NPD

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1223942400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1224115200000",
    "number": "1679725352",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2300 N MAYFAIR RD",
            "address_2": "SUITE 425",
            "city": "WAUWATOSA",
            "state": "WI",
            "postal_code": "532261505",
            "telephone_number": "414-727-4455",
            "fax_number": "414-727-4690"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2300 N MAYFAIR RD",
            "address_2": "SUITE 425",
            "city": "WAUWATOSA",
            "state": "WI",
            "postal_code": "532261505",
            "telephone_number": "414-727-4455",
            "fax_number": "414-727-4690"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PATHWAY ECLINIC SC",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-10-14",
        "last_updated": "2008-10-16",
        "status": "A",
        "authorized_official_last_name": "CORNELLA- CARLSON",
        "authorized_official_first_name": "TRACEY",
        "authorized_official_middle_name": "LEE",
        "authorized_official_title_or_position": "PSYCHIATRIST",
        "authorized_official_telephone_number": "414-727-4455",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "101YM0800X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Counselor, Mental Health",
            "state": "WI",
            "license": "2605",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Sarah Lynne Passage, R.N.
• Ankur N Patel, MD
• Parth Patel
• Prachi Vikas Patel, PHARMD
• Prapti Rajesh Patel
• Kathrine Lyn Patterson, PSYD
• Mary Patterson
• Lawrence Thomas Patti, DDS
• Megan Elizabeth Patti
• Rakesh Patyal

• Mental Health Counselor in Wauwatosa, WI
• Providers in Wauwatosa, WI by specialty
• Mental Health Counselor in Wisconsin

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 16, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.