Healthcare Provider Details

I. General information

NPI: 1245979103
Provider Name (Legal Business Name): BE THE BREAKTHROUGH COUNSELING SOLUTIONS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/31/2022
Last Update Date: 05/31/2022
Certification Date: 05/31/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3057 W 100TH ST
EVERGREEN PARK IL
60805-3506
US

IV. Provider business mailing address

3057 W 100TH ST
EVERGREEN PARK IL
60805-3506
US

V. Phone/Fax

Practice location:
  • Phone: 630-440-2764
  • Fax: 312-229-8845
Mailing address:
  • Phone: 630-440-2764
  • Fax: 312-229-8845

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code101YP1600X
TaxonomyPastoral Counselor
License Number
License Number State

VIII. Authorized Official

Name: BRITTANEY M STEVENSON
Title or Position: OWNER
Credential: BCCC
Phone: 630-440-2764