Healthcare Provider Details

I. General information

NPI: 1609795616
Provider Name (Legal Business Name): BROKEN BUT NOT SHATTERED DIVORCE RECOVERY COACHING
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/13/2026
Last Update Date: 07/13/2026
Certification Date: 07/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

580 LEADTREE LOOP
BUDA TX
78610-2239
US

IV. Provider business mailing address

1320 CABELAS DR UNIT 964
BUDA TX
78610-1840
US

V. Phone/Fax

Practice location:
  • Phone: 512-855-8321
  • Fax:
Mailing address:
  • Phone: 512-855-8321
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171400000X
TaxonomyHealth & Wellness Coach
License Number
License Number State

VIII. Authorized Official

Name: CAROLINE HUGHES
Title or Position: OWNER
Credential:
Phone: 512-855-8321