Provider Demographics
NPI:1851457840
Name:BREAKTHROUGH COUNSELING LLC
Entity type:Organization
Organization Name:BREAKTHROUGH COUNSELING LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:GARY
Authorized Official - Middle Name:T
Authorized Official - Last Name:EVANS
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:573-426-2588
Mailing Address - Street 1:901 N. PINE STREET
Mailing Address - Street 2:SUITE 101
Mailing Address - City:ROLLA
Mailing Address - State:MO
Mailing Address - Zip Code:65401-3181
Mailing Address - Country:US
Mailing Address - Phone:573-426-2588
Mailing Address - Fax:573-426-4859
Practice Address - Street 1:901 N. PINE STREET
Practice Address - Street 2:SUITE 101
Practice Address - City:ROLLA
Practice Address - State:MO
Practice Address - Zip Code:65401-3181
Practice Address - Country:US
Practice Address - Phone:573-426-2588
Practice Address - Fax:573-426-4859
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-28
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO0038191041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO$$$$$$$$$OtherGARY EVANS SSN