=====================================================
General NPI Number Information
=====================================================
NPI Number | 1740133891
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | BREAKING FORTH COUNSELING LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 02/18/2026
-----------------------------------------------------
Last Update Date | 02/18/2026
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 53998 DAKOTA LN
-----------------------------------------------------
City | NORTH MANKATO
-----------------------------------------------------
State | MN
-----------------------------------------------------
Zip | 56003-4117
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 612-997-0264
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 53998 DAKOTA LN
-----------------------------------------------------
City | NORTH MANKATO
-----------------------------------------------------
State | MN
-----------------------------------------------------
Zip | 56003-4117
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 612-997-0264
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | MRS. JESSICA LYNN SMITH
-----------------------------------------------------
Credential | MA, LMFT, LADC
-----------------------------------------------------
Telephone | 612-997-0264
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 106H00000X
-----------------------------------------------------
Taxonomy Name | Marriage & Family Therapist
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------