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General NPI Number Information
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NPI Number | 1972284958
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Entity Type | Organization
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Legal Business Name | BREAKING CYCLES COUNSELING
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Dates
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Enumeration Date | 07/31/2023
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Last Update Date | 03/19/2025
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Provider Practice Location Address
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Address Line | 12139 MOUNT VERNON AVE STE 105
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City | GRAND TERRACE
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State | CA
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Zip | 92313-5500
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Country | US
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Telephone | 951-903-8022
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Fax |
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Provider Business Mailing Address
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Address Line | 12139 MOUNT VERNON AVE STE 105
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City | GRAND TERRACE
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State | CA
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Zip | 92313-5500
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Country | US
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Telephone | 909-222-0096
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | KALISHA KORAN AYISHA BROWN
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Credential | LCSW
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Telephone | 909-222-0096
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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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 | 261QM1300X
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Taxonomy Name | Multi-Specialty 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 | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number |
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License Number State |
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