Provider Demographics
NPI:1578096525
Name:BREAKTHROUGH PSYCHOTHERAPEUTIC SOLUTIONS, LLC
Entity Type:Organization
Organization Name:BREAKTHROUGH PSYCHOTHERAPEUTIC SOLUTIONS, LLC
Other - Org Name:BPS, LLC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER/MEMBER
Authorized Official - Prefix:DR
Authorized Official - First Name:TESHAUNDA
Authorized Official - Middle Name:
Authorized Official - Last Name:HANNOR-WALKER
Authorized Official - Suffix:
Authorized Official - Credentials:PHD, LPC
Authorized Official - Phone:478-952-9438
Mailing Address - Street 1:323 PINE AVE STE 204
Mailing Address - Street 2:
Mailing Address - City:ALBANY
Mailing Address - State:GA
Mailing Address - Zip Code:31701-2587
Mailing Address - Country:US
Mailing Address - Phone:478-952-9438
Mailing Address - Fax:
Practice Address - Street 1:323 PINE AVE STE 204
Practice Address - Street 2:
Practice Address - City:ALBANY
Practice Address - State:GA
Practice Address - Zip Code:31701-2587
Practice Address - Country:US
Practice Address - Phone:478-952-9438
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-04-06
Last Update Date:2017-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GALPC005989101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Single Specialty