Provider Demographics
NPI:1013582535
Name:CHOSEN BREAKTHROUGH COLLABORATIVE LLC
Entity Type:Organization
Organization Name:CHOSEN BREAKTHROUGH COLLABORATIVE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMNISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:CATINA
Authorized Official - Middle Name:
Authorized Official - Last Name:ERWIN
Authorized Official - Suffix:
Authorized Official - Credentials:LPC-A
Authorized Official - Phone:832-781-8710
Mailing Address - Street 1:340 N SAM HOUSTON PKWY E STE A258
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77060-3305
Mailing Address - Country:US
Mailing Address - Phone:832-781-8710
Mailing Address - Fax:
Practice Address - Street 1:8901 JENSEN DR
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77093-6925
Practice Address - Country:US
Practice Address - Phone:832-781-8710
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-05-26
Last Update Date:2021-05-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes251S00000XAgenciesCommunity/Behavioral Health
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty
No251B00000XAgenciesCase Management
No251C00000XAgenciesDay Training, Developmentally Disabled Services