Provider Demographics
NPI:1992057558
Name:BREAKTHROUGH COUNSELING EDUCATION CENTER
Entity type:Organization
Organization Name:BREAKTHROUGH COUNSELING EDUCATION CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:SHEILA
Authorized Official - Middle Name:
Authorized Official - Last Name:DAVIS
Authorized Official - Suffix:
Authorized Official - Credentials:ED D, LMHC, NCC
Authorized Official - Phone:407-926-0319
Mailing Address - Street 1:1950 LEE ROAD
Mailing Address - Street 2:SUITE 114
Mailing Address - City:WINTER PARK
Mailing Address - State:FL
Mailing Address - Zip Code:32789-7210
Mailing Address - Country:US
Mailing Address - Phone:407-926-0319
Mailing Address - Fax:407-926-0294
Practice Address - Street 1:1950 LEE ROAD
Practice Address - Street 2:SUITE 114
Practice Address - City:WINTER PARK
Practice Address - State:FL
Practice Address - Zip Code:32789-7210
Practice Address - Country:US
Practice Address - Phone:407-926-0319
Practice Address - Fax:407-926-0294
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-10-07
Last Update Date:2017-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMH7613101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL767736700Medicaid