Provider Demographics
NPI:1609435015
Name:BREAKTHROUGH MENTAL HEALTH SERVICES LLC
Entity Type:Organization
Organization Name:BREAKTHROUGH MENTAL HEALTH SERVICES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MENTAL HEALTH THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:MEGAN
Authorized Official - Middle Name:
Authorized Official - Last Name:YORK
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:417-778-5033
Mailing Address - Street 1:PO BOX 334
Mailing Address - Street 2:
Mailing Address - City:WEST PLAINS
Mailing Address - State:MO
Mailing Address - Zip Code:65775-0334
Mailing Address - Country:US
Mailing Address - Phone:417-778-5033
Mailing Address - Fax:
Practice Address - Street 1:203 E MAIN ST
Practice Address - Street 2:
Practice Address - City:WEST PLAINS
Practice Address - State:MO
Practice Address - Zip Code:65775-3524
Practice Address - Country:US
Practice Address - Phone:417-505-9843
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-06-10
Last Update Date:2019-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO2006018050Medicaid
MO612447OtherBLUE CROSS BLUE SHIELD