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General NPI Number Information
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NPI Number | 1649641119
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Entity Type | Organization
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Legal Business Name | BREAKTHROUGH THERAPY OF FRISCO
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Dates
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Enumeration Date | 10/09/2015
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Last Update Date | 10/09/2015
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Provider Practice Location Address
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Address Line | 2770 MAIN ST SUITE 125
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City | FRISCO
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State | TX
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Zip | 75033-4302
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Country | US
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Telephone | 469-777-8448
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Fax |
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Provider Business Mailing Address
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Address Line | 2770 MAIN ST SUITE 125
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City | FRISCO
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State | TX
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Zip | 75033-4302
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Country | US
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Telephone | 469-777-8448
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | SHANNON WATERS-BLAND
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Credential |
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Telephone | 817-894-1122
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | 61178
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License Number State | TX
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Taxonomy #2
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 53730
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License Number State | TX
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