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General NPI Number Information
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NPI Number | 1063950624
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Entity Type | Organization
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Legal Business Name | BREAKTHROUGH FAMILY COUNSELING SERVICES
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Dates
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Enumeration Date | 02/03/2017
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Last Update Date | 02/28/2018
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Provider Practice Location Address
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Address Line | 3015 E SKELLY DR 211-7
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City | TULSA
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State | OK
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Zip | 74105-6317
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Country | US
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Telephone | 918-691-2575
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 33354
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City | TULSA
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State | OK
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Zip | 74153-3354
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Country | US
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Telephone | 918-691-2575
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Fax |
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Authorized Official
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Title or Position | EXECUTIVE DIRECTOR
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Name | CONSTANCE VERNETTA ALEXANDER
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Credential | LMFT
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Telephone | 918-691-2575
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number | 1044
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License Number State | OK
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