Healthcare Provider Details

I. General information

NPI: 1164055299
Provider Name (Legal Business Name): BREAKTHROUGH BARRIERS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/18/2020
Last Update Date: 02/18/2020
Certification Date: 02/18/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

958 EARLY AVE
WINTER PARK FL
32789-1756
US

IV. Provider business mailing address

1969 S ALAFAYA TRL # 346
ORLANDO FL
32828-8732
US

V. Phone/Fax

Practice location:
  • Phone: 678-431-4279
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code106E00000X
TaxonomyAssistant Behavior Analyst
License Number
License Number State

VIII. Authorized Official

Name: CATHERINE IVEY
Title or Position: CEO
Credential:
Phone: 678-431-4279