Healthcare Provider Details

I. General information

NPI: 1205292208
Provider Name (Legal Business Name): BREAKTHROUGH INTERVENTIONS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/06/2016
Last Update Date: 01/06/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4441 S XERIC WAY
DENVER CO
80237-2529
US

IV. Provider business mailing address

4441 S XERIC WAY
DENVER CO
80237-2529
US

V. Phone/Fax

Practice location:
  • Phone: 720-341-2324
  • Fax:
Mailing address:
  • Phone: 720-341-2324
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number751
License Number StateCO

VIII. Authorized Official

Name: ANNETTE NUNEZ
Title or Position: DIRECTOR
Credential:
Phone: 720-341-2324