Provider Demographics
NPI:1558127035
Name:BREAKING STASIS LLC
Entity Type:Organization
Organization Name:BREAKING STASIS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO/CLINICIAN
Authorized Official - Prefix:MR
Authorized Official - First Name:DREW
Authorized Official - Middle Name:
Authorized Official - Last Name:PEASE
Authorized Official - Suffix:
Authorized Official - Credentials:LMFT
Authorized Official - Phone:520-954-1877
Mailing Address - Street 1:100 S 7TH ST STE 4
Mailing Address - Street 2:
Mailing Address - City:SIERRA VISTA
Mailing Address - State:AZ
Mailing Address - Zip Code:85635-2509
Mailing Address - Country:US
Mailing Address - Phone:520-216-4068
Mailing Address - Fax:
Practice Address - Street 1:100 S 7TH ST STE 4
Practice Address - Street 2:
Practice Address - City:SIERRA VISTA
Practice Address - State:AZ
Practice Address - Zip Code:85635-2509
Practice Address - Country:US
Practice Address - Phone:520-216-4068
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-02-22
Last Update Date:2024-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
No261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health