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General NPI Number Information
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NPI Number | 1013582535
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Entity Type | Organization
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Legal Business Name | CHOSEN BREAKTHROUGH COLLABORATIVE LLC
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Dates
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Enumeration Date | 05/26/2021
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Last Update Date | 05/26/2021
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Provider Practice Location Address
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Address Line | 8901 JENSEN DR
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City | HOUSTON
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State | TX
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Zip | 77093-6925
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Country | US
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Telephone | 832-781-8710
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Fax |
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Provider Business Mailing Address
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Address Line | 340 N SAM HOUSTON PKWY E STE A258
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City | HOUSTON
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State | TX
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Zip | 77060-3305
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Country | US
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Telephone | 832-781-8710
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Fax |
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Authorized Official
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Title or Position | ADMNISTRATOR
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Name | CATINA ERWIN
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Credential | LPC-A
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Telephone | 832-781-8710
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 251B00000X
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Taxonomy Name | Case Management Agency
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 251C00000X
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Taxonomy Name | Developmentally Disabled Services Day Training Agency
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License Number |
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License Number State |
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Taxonomy #4
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number |
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License Number State |
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