Healthcare Provider Details

I. General information

NPI: 1336276518
Provider Name (Legal Business Name): BREAKTHROUGH CLUB OF SEDGWICK COUNTY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/27/2007
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1010 N MAIN ST
WICHITA KS
67203-3615
US

IV. Provider business mailing address

PO BOX 47563
WICHITA KS
67201-7563
US

V. Phone/Fax

Practice location:
  • Phone: 316-269-2534
  • Fax: 316-262-8882
Mailing address:
  • Phone: 316-269-2534
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code104100000X
TaxonomySocial Worker
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code163WP0808X
TaxonomyPsychiatric/Mental Health Registered Nurse
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number
License Number State

VIII. Authorized Official

Name: MRS. BARBARA ANDRES
Title or Position: EXECUTIVE DIRECTOR
Credential:
Phone: 316-269-2534