Provider Demographics
NPI:1457095986
Name:BREAKTHROUGH PSYCHOLOGY GROUP PC
Entity Type:Organization
Organization Name:BREAKTHROUGH PSYCHOLOGY GROUP PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JARED
Authorized Official - Middle Name:ABRAHAM
Authorized Official - Last Name:DOEGEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:909-276-7720
Mailing Address - Street 1:432 S SAN VICENTE BLVD STE 200
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90048-4192
Mailing Address - Country:US
Mailing Address - Phone:909-276-7720
Mailing Address - Fax:
Practice Address - Street 1:432 S SAN VICENTE BLVD STE 200
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90048-4192
Practice Address - Country:US
Practice Address - Phone:909-276-7720
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-04-21
Last Update Date:2022-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)
No103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Multi-Specialty
No103TH0004XBehavioral Health & Social Service ProvidersPsychologistHealthGroup - Multi-Specialty
No103TP2701XBehavioral Health & Social Service ProvidersPsychologistGroup PsychotherapyGroup - Multi-Specialty
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty