=====================================================
General NPI Number Information
=====================================================
NPI Number | 1497588750
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | BREAK FREE THERAPY GROUP
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/22/2024
-----------------------------------------------------
Last Update Date | 02/17/2026
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1766 SEA LARK LN # E5
-----------------------------------------------------
City | NAVARRE
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 32566-8190
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 850-206-5367
-----------------------------------------------------
Fax | 850-961-0054
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1766 SEA LARK LN # E5
-----------------------------------------------------
City | NAVARRE
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 32566-8190
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 850-206-5367
-----------------------------------------------------
Fax | 850-961-0054
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | CEO/THERAPIST
-----------------------------------------------------
Name | JOANNE E JACOBS
-----------------------------------------------------
Credential | LCSW
-----------------------------------------------------
Telephone | 850-206-5367
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 1041C0700X
-----------------------------------------------------
Taxonomy Name | Clinical Social Worker
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------