Provider Demographics
NPI:1144821539
Name:CPF BREAKTHROUGH, LLC
Entity type:Organization
Organization Name:CPF BREAKTHROUGH, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:LISA
Authorized Official - Middle Name:F
Authorized Official - Last Name:PARKER
Authorized Official - Suffix:
Authorized Official - Credentials:NCACII, SUDP
Authorized Official - Phone:509-927-6838
Mailing Address - Street 1:11711 E SPRAGUE AVE STE D4
Mailing Address - Street 2:
Mailing Address - City:SPOKANE VALLEY
Mailing Address - State:WA
Mailing Address - Zip Code:99206-6122
Mailing Address - Country:US
Mailing Address - Phone:509-927-6838
Mailing Address - Fax:509-927-6845
Practice Address - Street 1:11711 E SPRAGUE AVE STE D4
Practice Address - Street 2:
Practice Address - City:SPOKANE VALLEY
Practice Address - State:WA
Practice Address - Zip Code:99206-6122
Practice Address - Country:US
Practice Address - Phone:509-927-6838
Practice Address - Fax:509-927-6845
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:CPF BREAKTHROUGH, LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2020-11-03
Last Update Date:2024-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QR0405XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation, Substance Use Disorder
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Multi-Specialty
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty
No251B00000XAgenciesCase Management
No251S00000XAgenciesCommunity/Behavioral Health
No261Q00000XAmbulatory Health Care FacilitiesClinic/Center
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA61101238OtherBEHAVIOR HEALTH AGENCY SUBSTANCE USE & MENTAL HEALTH
WA61468012OtherBEHAVIOR HEALTH AGENCY SUBSTANCE USE & MENTAL HEALTH
WA2268076Medicaid