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General NPI Number Information
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NPI Number | 1043051238
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Entity Type | Organization
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Legal Business Name | BREAKTHROUGH WELLNESS CENTRE, LLC
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Dates
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Enumeration Date | 06/03/2024
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Last Update Date | 06/03/2024
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Provider Practice Location Address
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Address Line | 300 N OTTAWA ST
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City | JOLIET
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State | IL
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Zip | 60432-4009
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Country | US
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Telephone | 773-466-4961
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Fax | 773-466-9277
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Provider Business Mailing Address
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Address Line | 300 N OTTAWA ST
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City | JOLIET
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State | IL
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Zip | 60432-4009
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Country | US
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Telephone | 773-466-4961
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Fax | 773-466-9277
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Authorized Official
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Title or Position | CO-OWNER
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Name | DR. CHRISTINE JOHNSON
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Credential | DNP, APRN
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Telephone | 815-557-9191
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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 | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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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 | 106H00000X
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Taxonomy Name | Marriage & Family Therapist
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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 | 2084P0800X
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Taxonomy Name | Psychiatry Physician
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License Number |
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License Number State |
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Taxonomy #5
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Taxonomy Code | 363LP0808X
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Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
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License Number |
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License Number State |
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