MEDICARE: BREAKING FORTH COUNSELING LLC

Medicare Provider Information

Scope of Practice

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

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	106H00000X	Marriage & Family Therapist

General Provider Information

NPI Number	:	1740133891
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BREAKING FORTH COUNSELING LLC

Provider Business Mailing Address
First Line	:	53998 DAKOTA LN
Second Line	:
City	:	NORTH MANKATO
State	:	MN
Zip	:	56003-4117
Country	:	US
Telephone Number	:	612-997-0264
Fax Number	:

Provider Business Practice Location Address
First Line	:	53998 DAKOTA LN
Second Line	:
City	:	NORTH MANKATO
State	:	MN
Zip	:	56003-4117
Country	:	US
Telephone Number	:	612-997-0264
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	MRS. JESSICA LYNN SMITH
Credential	:	MA, LMFT, LADC
Telephone Number	:	612-997-0264

Provider Enumeration Date	:	02/18/2026
Last Update Date	:	02/18/2026

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