Provider Demographics
NPI:1174863419
Name:BREAKING BOXES
Entity Type:Organization
Organization Name:BREAKING BOXES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:PENNI
Authorized Official - Middle Name:LANE
Authorized Official - Last Name:SEARS
Authorized Official - Suffix:
Authorized Official - Credentials:LMFT, LADAC
Authorized Official - Phone:575-297-4039
Mailing Address - Street 1:606 IVY ST
Mailing Address - Street 2:
Mailing Address - City:TRUTH OR CONSEQUENCES
Mailing Address - State:NM
Mailing Address - Zip Code:87901-1634
Mailing Address - Country:US
Mailing Address - Phone:575-297-4039
Mailing Address - Fax:
Practice Address - Street 1:606 IVY ST
Practice Address - Street 2:
Practice Address - City:TRUTH OR CONSEQUENCES
Practice Address - State:NM
Practice Address - Zip Code:87901-1634
Practice Address - Country:US
Practice Address - Phone:575-297-4039
Practice Address - Fax:575-297-4039
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-02-23
Last Update Date:2022-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health