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General NPI Number Information
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NPI Number | 1780498527
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Entity Type | Organization
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Legal Business Name | BREAKTHROUGH NEUROFEEDBACK
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Dates
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Enumeration Date | 02/03/2025
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Last Update Date | 04/29/2025
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Provider Practice Location Address
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Address Line | 7045 CAMPUS DR STE 201
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City | COLORADO SPRINGS
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State | CO
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Zip | 80920-6561
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Country | US
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Telephone | 719-800-7814
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Fax | 719-457-6102
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Provider Business Mailing Address
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Address Line | 7045 CAMPUS DR STE 201
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City | COLORADO SPRINGS
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State | CO
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Zip | 80920-6561
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Country | US
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Telephone | 719-800-7814
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Fax | 719-457-6102
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Authorized Official
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Title or Position | OWNER
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Name | RAQUEL YOUNGLOVE
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Credential | OWNER
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Telephone | 719-800-7814
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM0850X
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Taxonomy Name | Adult Mental Health Clinic/Center
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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 | 261QM0855X
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Taxonomy Name | Adolescent and Children Mental Health Clinic/Center
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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 | 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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