Provider Demographics
NPI:1295240265
Name:BREAKING BARRIERS LLC
Entity type:Organization
Organization Name:BREAKING BARRIERS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR OF SERVICES
Authorized Official - Prefix:
Authorized Official - First Name:KELLY
Authorized Official - Middle Name:MICHAEL
Authorized Official - Last Name:WELSH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:952-303-3489
Mailing Address - Street 1:14500 BURNHAVEN DR STE 123
Mailing Address - Street 2:
Mailing Address - City:BURNSVILLE
Mailing Address - State:MN
Mailing Address - Zip Code:55306-4926
Mailing Address - Country:US
Mailing Address - Phone:952-303-3489
Mailing Address - Fax:
Practice Address - Street 1:14500 BURNHAVEN DR STE 123
Practice Address - Street 2:
Practice Address - City:BURNSVILLE
Practice Address - State:MN
Practice Address - Zip Code:55306-4926
Practice Address - Country:US
Practice Address - Phone:952-303-3489
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-12-12
Last Update Date:2017-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN6352077OtherMN DHS LICENSING