Provider Demographics
NPI:1609490960
Name:BREAKFORTH COUNSELING AND CONSULTING LLC
Entity Type:Organization
Organization Name:BREAKFORTH COUNSELING AND CONSULTING LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINICAL PSYCHOLOGIST/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:GILBERT
Authorized Official - Middle Name:TODD
Authorized Official - Last Name:VANCE
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:540-556-4356
Mailing Address - Street 1:3959 ELECTRIC RD STE 425
Mailing Address - Street 2:
Mailing Address - City:ROANOKE
Mailing Address - State:VA
Mailing Address - Zip Code:24018-4563
Mailing Address - Country:US
Mailing Address - Phone:540-556-4356
Mailing Address - Fax:
Practice Address - Street 1:3959 ELECTRIC RD STE 425
Practice Address - Street 2:
Practice Address - City:ROANOKE
Practice Address - State:VA
Practice Address - Zip Code:24018-4563
Practice Address - Country:US
Practice Address - Phone:540-556-4356
Practice Address - Fax:540-266-7511
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-06-02
Last Update Date:2020-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)