Provider Demographics
NPI:1699537399
Name:BROKEN MADE BEAUTIFUL COUNSELING LLC
Entity type:Organization
Organization Name:BROKEN MADE BEAUTIFUL COUNSELING LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:SARAH
Authorized Official - Middle Name:LYNN
Authorized Official - Last Name:BARDUA
Authorized Official - Suffix:
Authorized Official - Credentials:LPC
Authorized Official - Phone:570-690-8881
Mailing Address - Street 1:1000 MARKET ST STE 41
Mailing Address - Street 2:
Mailing Address - City:BLOOMSBURG
Mailing Address - State:PA
Mailing Address - Zip Code:17815-2601
Mailing Address - Country:US
Mailing Address - Phone:570-690-8881
Mailing Address - Fax:
Practice Address - Street 1:1000 MARKET ST STE 41
Practice Address - Street 2:
Practice Address - City:BLOOMSBURG
Practice Address - State:PA
Practice Address - Zip Code:17815-2601
Practice Address - Country:US
Practice Address - Phone:570-690-8881
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-01-29
Last Update Date:2024-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Single Specialty