MEDICARE: BREAKTHROUGH COUNSELING SERVICES, LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy
1	261QM0801X	Mental Health Clinic/Center (Including Community Mental Health Center)
2	261QM0850X	Adult Mental Health Clinic/Center
3	261QM0855X	Adolescent and Children Mental Health Clinic/Center
4	251S00000X	Community/Behavioral Health Agency

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1508324781
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BREAKTHROUGH COUNSELING SERVICES, LLC

Provider Business Mailing Address
First Line	:	3105 W AZEELE ST
Second Line	:
City	:	TAMPA
State	:	FL
Zip	:	33609-3089
Country	:	US
Telephone Number	:	813-966-1514
Fax Number	:

Provider Business Practice Location Address
First Line	:	3105 W AZEELE ST
Second Line	:
City	:	TAMPA
State	:	FL
Zip	:	33609-3089
Country	:	US
Telephone Number	:	813-966-1514
Fax Number	:

Authorized Official
Title or Position	:	MENTAL HEALTH THERAPIST
Name	:	MS. PAMELA MILBRY
Credential	:	LMHC
Telephone Number	:	813-966-1514

Provider Enumeration Date	:	03/07/2019
Last Update Date	:	03/07/2019

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