Provider Demographics
NPI:1629513627
Name:BREAKTHROUGHS LAKE COUNTY
Entity Type:Organization
Organization Name:BREAKTHROUGHS LAKE COUNTY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JESSICA
Authorized Official - Middle Name:C
Authorized Official - Last Name:GOSCHY
Authorized Official - Suffix:
Authorized Official - Credentials:LPC
Authorized Official - Phone:847-913-6212
Mailing Address - Street 1:2402 DEERPATH DR
Mailing Address - Street 2:
Mailing Address - City:LINDENHURST
Mailing Address - State:IL
Mailing Address - Zip Code:60046-9074
Mailing Address - Country:US
Mailing Address - Phone:847-913-6212
Mailing Address - Fax:
Practice Address - Street 1:2402 DEERPATH DR
Practice Address - Street 2:
Practice Address - City:LINDENHURST
Practice Address - State:IL
Practice Address - Zip Code:60046-9074
Practice Address - Country:US
Practice Address - Phone:847-913-6212
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-12-29
Last Update Date:2016-12-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL178.012232101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Single Specialty