Provider Demographics
NPI:1033921044
Name:BREAKING GRIT, LLC
Entity type:Organization
Organization Name:BREAKING GRIT, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:JOINT OWNERSHIP
Authorized Official - Prefix:
Authorized Official - First Name:KEYARA
Authorized Official - Middle Name:
Authorized Official - Last Name:TABBERT
Authorized Official - Suffix:
Authorized Official - Credentials:LMFT
Authorized Official - Phone:608-344-0053
Mailing Address - Street 1:W10174 29TH ST
Mailing Address - Street 2:
Mailing Address - City:CAMP DOUGLAS
Mailing Address - State:WI
Mailing Address - Zip Code:54618-9709
Mailing Address - Country:US
Mailing Address - Phone:608-344-0053
Mailing Address - Fax:
Practice Address - Street 1:W10174 29TH ST
Practice Address - Street 2:
Practice Address - City:CAMP DOUGLAS
Practice Address - State:WI
Practice Address - Zip Code:54618-9709
Practice Address - Country:US
Practice Address - Phone:608-344-0053
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-01-25
Last Update Date:2025-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Single Specialty