Provider Demographics
NPI:1932896628
Name:NOT BROKEN THERAPY LLC
Entity Type:Organization
Organization Name:NOT BROKEN THERAPY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:THERAPIST
Authorized Official - Prefix:MR
Authorized Official - First Name:ERRIC
Authorized Official - Middle Name:ROMO
Authorized Official - Last Name:CARREON
Authorized Official - Suffix:
Authorized Official - Credentials:LMFT-A
Authorized Official - Phone:210-464-3398
Mailing Address - Street 1:PO BOX 985
Mailing Address - Street 2:
Mailing Address - City:CIBOLO
Mailing Address - State:TX
Mailing Address - Zip Code:78108-0985
Mailing Address - Country:US
Mailing Address - Phone:210-464-3398
Mailing Address - Fax:
Practice Address - Street 1:109 LOOKOUT VW
Practice Address - Street 2:
Practice Address - City:CIBOLO
Practice Address - State:TX
Practice Address - Zip Code:78108-3389
Practice Address - Country:US
Practice Address - Phone:210-464-3398
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-04-21
Last Update Date:2023-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Multi-Specialty