Provider Demographics
NPI:1598548976
Name:BREAKING ILLUSIONS COUNSELING LLC
Entity Type:Organization
Organization Name:BREAKING ILLUSIONS COUNSELING LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINICAL MENTAL HEALTH COUNSELOR
Authorized Official - Prefix:
Authorized Official - First Name:WHITNEY
Authorized Official - Middle Name:LYNN
Authorized Official - Last Name:GRAY
Authorized Official - Suffix:
Authorized Official - Credentials:LMHC, OWNER
Authorized Official - Phone:712-260-3117
Mailing Address - Street 1:PO BOX 25
Mailing Address - Street 2:
Mailing Address - City:ARNOLDS PARK
Mailing Address - State:IA
Mailing Address - Zip Code:51331-0025
Mailing Address - Country:US
Mailing Address - Phone:712-260-3117
Mailing Address - Fax:
Practice Address - Street 1:2230 33RD ST STE 8
Practice Address - Street 2:
Practice Address - City:SPIRIT LAKE
Practice Address - State:IA
Practice Address - Zip Code:51360-7632
Practice Address - Country:US
Practice Address - Phone:712-260-3117
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-08-17
Last Update Date:2023-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty