Provider Demographics
NPI:1639898968
Name:BREAKING FREE FROM TRAUMA, LLC
Entity type:Organization
Organization Name:BREAKING FREE FROM TRAUMA, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PSYCHOLOGIST/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:DONNA
Authorized Official - Middle Name:FLORENCE
Authorized Official - Last Name:LAMAR
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:231-335-0952
Mailing Address - Street 1:3196 FENNER RD
Mailing Address - Street 2:
Mailing Address - City:MUSKEGON
Mailing Address - State:MI
Mailing Address - Zip Code:49445-1826
Mailing Address - Country:US
Mailing Address - Phone:231-335-0952
Mailing Address - Fax:
Practice Address - Street 1:1516 PECK STREET
Practice Address - Street 2:MUSKEGON MI 49441
Practice Address - City:MUSKEGON
Practice Address - State:MI
Practice Address - Zip Code:49441
Practice Address - Country:US
Practice Address - Phone:231-335-0952
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-08-22
Last Update Date:2024-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Single Specialty