Provider Demographics
NPI:1417780925
Name:BREAKTHROUGH PSYCHOTHERAPY, LLO
Entity type:Organization
Organization Name:BREAKTHROUGH PSYCHOTHERAPY, LLO
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PSYCHOLOGIST, OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ANDREA
Authorized Official - Middle Name:
Authorized Official - Last Name:GODDARD
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD
Authorized Official - Phone:773-677-7960
Mailing Address - Street 1:570 W. FRONTAGE ROAD
Mailing Address - Street 2:SUITE 370
Mailing Address - City:NORTHFIELD
Mailing Address - State:IL
Mailing Address - Zip Code:60093
Mailing Address - Country:US
Mailing Address - Phone:773-322-1363
Mailing Address - Fax:
Practice Address - Street 1:570 WEST FRONTAGE ROAD
Practice Address - Street 2:SUITE 370
Practice Address - City:NORTHFIELD
Practice Address - State:IL
Practice Address - Zip Code:60093
Practice Address - Country:US
Practice Address - Phone:773-322-1363
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-08-21
Last Update Date:2024-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health