Provider Demographics
NPI:1659895159
Name:BREAKTHROUGHS OF NORTH FLORIDA LLC
Entity Type:Organization
Organization Name:BREAKTHROUGHS OF NORTH FLORIDA LLC
Other - Org Name:BREAKTHROUGHS OF NORTH FLORIDA
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:MARTY
Authorized Official - Middle Name:ROWLAND
Authorized Official - Last Name:EDWARDS
Authorized Official - Suffix:
Authorized Official - Credentials:LMFT
Authorized Official - Phone:904-849-1190
Mailing Address - Street 1:87003 PROFESSIONAL WAY
Mailing Address - Street 2:
Mailing Address - City:YULEE
Mailing Address - State:FL
Mailing Address - Zip Code:32097-3400
Mailing Address - Country:US
Mailing Address - Phone:904-849-1190
Mailing Address - Fax:
Practice Address - Street 1:87003 PROFESSIONAL WAY
Practice Address - Street 2:
Practice Address - City:YULEE
Practice Address - State:FL
Practice Address - Zip Code:32097-3400
Practice Address - Country:US
Practice Address - Phone:904-849-1190
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-07-27
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMT3313106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Single Specialty