Provider Demographics
NPI:1598374118
Name:BREAKTHROUGH SERVICES LLC
Entity Type:Organization
Organization Name:BREAKTHROUGH SERVICES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:TETIA
Authorized Official - Middle Name:TEREZ
Authorized Official - Last Name:HENSON
Authorized Official - Suffix:
Authorized Official - Credentials:LMFT/LPCC
Authorized Official - Phone:562-264-5917
Mailing Address - Street 1:12821 NEWPORT AVE
Mailing Address - Street 2:
Mailing Address - City:TUSTIN
Mailing Address - State:CA
Mailing Address - Zip Code:92780
Mailing Address - Country:US
Mailing Address - Phone:562-264-5917
Mailing Address - Fax:714-333-4848
Practice Address - Street 1:12821 NEWPORT AVE
Practice Address - Street 2:
Practice Address - City:TUSTIN
Practice Address - State:CA
Practice Address - Zip Code:92780
Practice Address - Country:US
Practice Address - Phone:562-264-5917
Practice Address - Fax:714-333-4848
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-07-29
Last Update Date:2020-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes251S00000XAgenciesCommunity/Behavioral Health
No106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Multi-Specialty