Provider Demographics
NPI:1477383669
Name:BROKEN THINGS THERAPY PLLC
Entity type:Organization
Organization Name:BROKEN THINGS THERAPY PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JESSICA
Authorized Official - Middle Name:
Authorized Official - Last Name:WILLIAMS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:414-852-5712
Mailing Address - Street 1:331 ASHLAND DR
Mailing Address - Street 2:
Mailing Address - City:GOLDSTON
Mailing Address - State:NC
Mailing Address - Zip Code:27252-9651
Mailing Address - Country:US
Mailing Address - Phone:414-852-5712
Mailing Address - Fax:984-977-4844
Practice Address - Street 1:331 ASHLAND DR
Practice Address - Street 2:
Practice Address - City:GOLDSTON
Practice Address - State:NC
Practice Address - Zip Code:27252-9651
Practice Address - Country:US
Practice Address - Phone:414-852-5712
Practice Address - Fax:984-977-4844
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-08-03
Last Update Date:2024-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselorGroup - Single Specialty