Provider Demographics
NPI:1003123597
Name:BREAKING THE MENTAL CHAINS, LLC
Entity Type:Organization
Organization Name:BREAKING THE MENTAL CHAINS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:ED
Authorized Official - Middle Name:
Authorized Official - Last Name:MELTON
Authorized Official - Suffix:
Authorized Official - Credentials:LPC
Authorized Official - Phone:417-894-2731
Mailing Address - Street 1:PO BOX 14462
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:MO
Mailing Address - Zip Code:65814-0462
Mailing Address - Country:US
Mailing Address - Phone:417-894-2731
Mailing Address - Fax:417-890-7757
Practice Address - Street 1:1522 E CAMINO ALTO ST
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:MO
Practice Address - Zip Code:65804-7303
Practice Address - Country:US
Practice Address - Phone:417-894-2731
Practice Address - Fax:417-890-7757
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-09-07
Last Update Date:2010-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MOLC1083359251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health