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General NPI Number Information
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NPI Number | 1457095986
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Entity Type | Organization
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Legal Business Name | BREAKTHROUGH PSYCHOLOGY GROUP PC
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Dates
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Enumeration Date | 04/21/2022
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Last Update Date | 05/06/2022
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Provider Practice Location Address
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Address Line | 432 S SAN VICENTE BLVD STE 200
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City | LOS ANGELES
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State | CA
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Zip | 90048-4192
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Country | US
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Telephone | 909-276-7720
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Fax |
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Provider Business Mailing Address
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Address Line | 432 S SAN VICENTE BLVD STE 200
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City | LOS ANGELES
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State | CA
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Zip | 90048-4192
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Country | US
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Telephone | 909-276-7720
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | JARED ABRAHAM DOEGEY
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Credential |
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Telephone | 909-276-7720
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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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 | 103TH0004X
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Taxonomy Name | Health Psychologist
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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 | 103TP2701X
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Taxonomy Name | Group Psychotherapy Psychologist
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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 | 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 #5
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Taxonomy Code | 261QM0801X
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Taxonomy Name | Mental Health Clinic/Center (Including Community Mental Health Center)
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License Number |
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License Number State |
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