Provider Demographics
NPI:1356959589
Name:BREAKING BARRIERS TOGETHER
Entity type:Organization
Organization Name:BREAKING BARRIERS TOGETHER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINICIAN
Authorized Official - Prefix:MR
Authorized Official - First Name:XANDER
Authorized Official - Middle Name:
Authorized Official - Last Name:FAISON
Authorized Official - Suffix:
Authorized Official - Credentials:LMFT
Authorized Official - Phone:443-876-0637
Mailing Address - Street 1:14300 N PENNSYLVANIA AVE APT 326
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73134-6063
Mailing Address - Country:US
Mailing Address - Phone:405-568-1338
Mailing Address - Fax:
Practice Address - Street 1:14300 N PENNSYLVANIA AVE APT 326
Practice Address - Street 2:
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73134-6063
Practice Address - Country:US
Practice Address - Phone:405-568-1338
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-07-14
Last Update Date:2021-07-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TF0000XBehavioral Health & Social Service ProvidersPsychologistFamilyGroup - Multi-Specialty
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty
No251B00000XAgenciesCase ManagementGroup - Multi-Specialty
No251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK0578458974Medicaid