Provider Demographics
NPI:1013612407
Name:BREAKTHROUGH PSYCHIATRY LLC
Entity Type:Organization
Organization Name:BREAKTHROUGH PSYCHIATRY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:LILIAN
Authorized Official - Middle Name:
Authorized Official - Last Name:ONWUKA
Authorized Official - Suffix:
Authorized Official - Credentials:NP
Authorized Official - Phone:719-423-0694
Mailing Address - Street 1:3000 WEDGEWOOD DRIVE
Mailing Address - Street 2:PO BOX 3834
Mailing Address - City:PUEBLO
Mailing Address - State:CO
Mailing Address - Zip Code:81005-0834
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:803 W 4TH ST STE U
Practice Address - Street 2:
Practice Address - City:PUEBLO
Practice Address - State:CO
Practice Address - Zip Code:81003-2392
Practice Address - Country:US
Practice Address - Phone:719-423-0694
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-04-04
Last Update Date:2023-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Single Specialty