Provider Demographics
NPI:1467132530
Name:KBB PSYCHOTHERAPY, LLC
Entity Type:Organization
Organization Name:KBB PSYCHOTHERAPY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PROVIDER
Authorized Official - Prefix:
Authorized Official - First Name:KRISTEN
Authorized Official - Middle Name:
Authorized Official - Last Name:BREAULT-BOLIO
Authorized Official - Suffix:
Authorized Official - Credentials:MS, LMCHC, LADC
Authorized Official - Phone:802-944-4718
Mailing Address - Street 1:183 TALCOTT RD STE 206
Mailing Address - Street 2:
Mailing Address - City:WILLISTON
Mailing Address - State:VT
Mailing Address - Zip Code:05495-2075
Mailing Address - Country:US
Mailing Address - Phone:802-944-4718
Mailing Address - Fax:
Practice Address - Street 1:183 TALCOTT RD STE 206
Practice Address - Street 2:
Practice Address - City:WILLISTON
Practice Address - State:VT
Practice Address - Zip Code:05495-2075
Practice Address - Country:US
Practice Address - Phone:802-944-4718
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-07-24
Last Update Date:2023-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)