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General NPI Number Information
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NPI Number | 1285035675
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Entity Type | Organization
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Legal Business Name | BREAKTHRU COUNSELING LLC
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Dates
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Enumeration Date | 09/04/2014
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Last Update Date | 09/04/2014
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Provider Practice Location Address
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Address Line | 3005 BRODHEAD RD SUITE185
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City | BETHLEHEM
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State | PA
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Zip | 18020-9201
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Country | US
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Telephone | 484-809-0454
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Fax |
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Provider Business Mailing Address
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Address Line | 3005 BRODHEAD RD SUITE185
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City | BETHLEHEM
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State | PA
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Zip | 18020-9201
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Country | US
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Telephone | 484-809-0454
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Fax |
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Authorized Official
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Title or Position | CLINICAL SOCIAL WORKER
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Name | AMELIA RENSHAW
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Credential | LCSW
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Telephone | 484-809-0454
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | CW017025
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License Number State | PA
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