Provider Demographics
NPI:1497588750
Name:BREAK FREE THERAPY GROUP, LLC
Entity type:Organization
Organization Name:BREAK FREE THERAPY GROUP, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO/THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:JOANNE
Authorized Official - Middle Name:E
Authorized Official - Last Name:JACOBS
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:850-206-5367
Mailing Address - Street 1:1991 COMMODORE DR
Mailing Address - Street 2:
Mailing Address - City:NAVARRE
Mailing Address - State:FL
Mailing Address - Zip Code:32566-7651
Mailing Address - Country:US
Mailing Address - Phone:850-206-5367
Mailing Address - Fax:850-961-0054
Practice Address - Street 1:1766 SEA LARK LN # E5
Practice Address - Street 2:
Practice Address - City:NAVARRE
Practice Address - State:FL
Practice Address - Zip Code:32566-8190
Practice Address - Country:US
Practice Address - Phone:850-206-5367
Practice Address - Fax:850-961-0054
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-08-22
Last Update Date:2024-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty