Provider Demographics
NPI:1427760289
Name:UNBROKEN CLINIC LLC
Entity type:Organization
Organization Name:UNBROKEN CLINIC LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/EMPLOYEE
Authorized Official - Prefix:MRS
Authorized Official - First Name:CARRIE
Authorized Official - Middle Name:PLAYER
Authorized Official - Last Name:SEXTON
Authorized Official - Suffix:
Authorized Official - Credentials:MS MA, BS
Authorized Official - Phone:334-545-7136
Mailing Address - Street 1:101 MISTY FOREST DR
Mailing Address - Street 2:
Mailing Address - City:PHENIX CITY
Mailing Address - State:AL
Mailing Address - Zip Code:36869-3492
Mailing Address - Country:US
Mailing Address - Phone:229-460-2361
Mailing Address - Fax:706-287-1124
Practice Address - Street 1:101 MISTY FOREST DR
Practice Address - Street 2:
Practice Address - City:PHENIX CITY
Practice Address - State:AL
Practice Address - Zip Code:36869-3492
Practice Address - Country:US
Practice Address - Phone:229-460-2361
Practice Address - Fax:706-287-1124
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-12-22
Last Update Date:2022-12-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA1376784587Medicaid
GA1376269910Medicaid