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General NPI Number Information
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NPI Number | 1851058242
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Entity Type | Organization
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Legal Business Name | BREAKTHROUGH BEHAVIORAL CARE, LLC
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Dates
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Enumeration Date | 11/21/2021
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Last Update Date | 12/02/2021
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Provider Practice Location Address
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Address Line | 3115 ELM ST
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City | SAINT CHARLES
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State | MO
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Zip | 63301-4651
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Country | US
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Telephone | 636-219-7524
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Fax | 877-526-8367
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Provider Business Mailing Address
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Address Line | 416 CONCORDIA LN
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City | SAINT CHARLES
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State | MO
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Zip | 63301-4608
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Country | US
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Telephone | 636-219-7524
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Fax | 877-526-8367
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Authorized Official
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Title or Position | OWNER/MANAGER/PRACTITIONER
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Name | DANIEL ROBB
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Credential | LPC
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Telephone | 636-219-7524
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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 |
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License Number State |
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