Provider Demographics
NPI:1982299053
Name:BREAKTHROUGH THERAPY
Entity Type:Organization
Organization Name:BREAKTHROUGH THERAPY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:HALEY
Authorized Official - Middle Name:
Authorized Official - Last Name:SITTERUD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:435-592-3399
Mailing Address - Street 1:85 N 300 W STE A
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:UT
Mailing Address - Zip Code:84780-3563
Mailing Address - Country:US
Mailing Address - Phone:435-414-8658
Mailing Address - Fax:435-359-5247
Practice Address - Street 1:230 N 1680 E STE T2
Practice Address - Street 2:
Practice Address - City:ST GEORGE
Practice Address - State:UT
Practice Address - Zip Code:84790-2573
Practice Address - Country:US
Practice Address - Phone:435-414-8658
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-03-01
Last Update Date:2022-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
1306108493OtherNPPES