Healthcare Provider Details

I. General information

NPI: 1144821539
Provider Name (Legal Business Name): CPF BREAKTHROUGH, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/03/2020
Last Update Date: 01/31/2024
Certification Date: 01/31/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11711 E SPRAGUE AVE STE D4
SPOKANE VALLEY WA
99206-6122
US

IV. Provider business mailing address

11711 E SPRAGUE AVE STE D4
SPOKANE VALLEY WA
99206-6122
US

V. Phone/Fax

Practice location:
  • Phone: 509-927-6838
  • Fax: 509-927-6845
Mailing address:
  • Phone: 509-927-6838
  • Fax: 509-927-6845

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code251B00000X
TaxonomyCase Management Agency
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number
License Number State
# 6
Primary TaxonomyY
Taxonomy Code261QR0405X
TaxonomySubstance Use Disorder Rehabilitation Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: LISA F PARKER
Title or Position: EXECUTIVE DIRECTOR
Credential: NCACII, SUDP
Phone: 509-927-6838