Healthcare Provider Details

I. General information

NPI: 1285539213
Provider Name (Legal Business Name): BREK THERAPY AND WELLNESS, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/09/2026
Last Update Date: 10/09/2026
Certification Date: 10/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6072 BRYNWOOD DR STE 205
ROCKFORD IL
61114-5829
US

IV. Provider business mailing address

4582 CINNAMON LN
ROCKFORD IL
61114-5326
US

V. Phone/Fax

Practice location:
  • Phone: 815-242-1213
  • Fax:
Mailing address:
  • Phone: 815-979-1195
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number StateNULL

VIII. Authorized Official

Name: ELIZABETH BREKELBAUM
Title or Position: LICENSED CLINICAL PROFESSIONAL COUN
Credential: LCPC
Phone: 815-979-1195