Provider Demographics
NPI:1356737613
Name:BREAKTHROUGH PSYCHOLOGICAL SERVICES, LLC
Entity type:Organization
Organization Name:BREAKTHROUGH PSYCHOLOGICAL SERVICES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/CLINICAL THERAPIST
Authorized Official - Prefix:MS
Authorized Official - First Name:CYNTHIA
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:GOEHRING
Authorized Official - Suffix:
Authorized Official - Credentials:LPC-MH
Authorized Official - Phone:605-725-5505
Mailing Address - Street 1:404 S LINCOLN ST STE L1
Mailing Address - Street 2:
Mailing Address - City:ABERDEEN
Mailing Address - State:SD
Mailing Address - Zip Code:57401-4373
Mailing Address - Country:US
Mailing Address - Phone:605-725-5505
Mailing Address - Fax:605-725-5508
Practice Address - Street 1:404 S LINCOLN ST STE L1
Practice Address - Street 2:
Practice Address - City:ABERDEEN
Practice Address - State:SD
Practice Address - Zip Code:57401-4373
Practice Address - Country:US
Practice Address - Phone:605-725-5505
Practice Address - Fax:605-725-5508
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-04-13
Last Update Date:2015-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SDLPCMH2258101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Single Specialty