Provider Demographics
NPI:1922854421
Name:BREAKTHROUGH BEHAVIORAL SERVICES
Entity type:Organization
Organization Name:BREAKTHROUGH BEHAVIORAL SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINICAL DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:LEANNA
Authorized Official - Middle Name:D
Authorized Official - Last Name:KYLE
Authorized Official - Suffix:
Authorized Official - Credentials:ME D, BCBA, LBA
Authorized Official - Phone:843-592-8582
Mailing Address - Street 1:221 TIBTON CIR
Mailing Address - Street 2:
Mailing Address - City:MYRTLE BEACH
Mailing Address - State:SC
Mailing Address - Zip Code:29588-1203
Mailing Address - Country:US
Mailing Address - Phone:843-592-8582
Mailing Address - Fax:
Practice Address - Street 1:221 TIBTON CIR
Practice Address - Street 2:
Practice Address - City:MYRTLE BEACH
Practice Address - State:SC
Practice Address - Zip Code:29588-1203
Practice Address - Country:US
Practice Address - Phone:843-592-8582
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-04-25
Last Update Date:2024-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior AnalystGroup - Multi-Specialty
No101YS0200XBehavioral Health & Social Service ProvidersCounselorSchoolGroup - Multi-Specialty
No1041S0200XBehavioral Health & Social Service ProvidersSocial WorkerSchoolGroup - Multi-Specialty
No171M00000XOther Service ProvidersCase Manager/Care CoordinatorGroup - Multi-Specialty