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General NPI Number Information
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NPI Number | 1336276518
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Entity Type | Organization
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Legal Business Name | BREAKTHROUGH CLUB OF SEDGWICK COUNTY
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Dates
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Enumeration Date | 02/27/2007
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Last Update Date | 09/11/2025
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Provider Practice Location Address
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Address Line | 1010 N MAIN ST
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City | WICHITA
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State | KS
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Zip | 67203-3615
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Country | US
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Telephone | 316-269-2534
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Fax | 316-262-8882
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Provider Business Mailing Address
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Address Line | PO BOX 47563
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City | WICHITA
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State | KS
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Zip | 67201-7563
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Country | US
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Telephone | 316-269-2534
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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 | MRS. BARBARA ANDRES
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Credential |
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Telephone | 316-269-2534
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 104100000X
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Taxonomy Name | Social Worker
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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 | 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 #3
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Taxonomy Code | 163WP0808X
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Taxonomy Name | Psychiatric/Mental Health Registered Nurse
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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 | 101Y00000X
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Taxonomy Name | Counselor
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License Number |
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License Number State |
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