1386397883 NPI number — BREAKING THROUGH COUNSELING PLLC

Table of content: (NPI 1386397883)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1386397883 NPI number — BREAKING THROUGH COUNSELING PLLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
BREAKING THROUGH COUNSELING PLLC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
BREAKING THROUGH COUNSELING PLLC
Provider Other Organization Name Type Code:
5
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1386397883
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/22/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
200 N TRAVIS ST STE 414
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SHERMAN
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
75090-0005
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
903-231-3509
Provider Business Mailing Address Fax Number:
903-225-8473

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
200 N TRAVIS ST STE 414
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SHERMAN
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
75090-0005
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
903-231-3509
Provider Business Practice Location Address Fax Number:
903-225-8473
Provider Enumeration Date:
02/03/2022

Additional Information

Authorized Official

Authorized Official Last Name:
WRENN
Authorized Official First Name:
KEVIN
Authorized Official Middle Name:
Authorized Official Title or Position:
OWNER/ LPC
Authorized Official Telephone Number:
903-231-3509

Provider Taxonomy Codes

  • Taxonomy code: 101Y00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 73235 . This is a "LICENSE#" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".




Copyright © 2007-2024 www.npivalidator.com