Provider Demographics
NPI:1528429347
Name:BREAKING CYCLES INC.,
Entity type:Organization
Organization Name:BREAKING CYCLES INC.,
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:COO/THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:DEON
Authorized Official - Middle Name:DUPREE
Authorized Official - Last Name:WHITESIDE
Authorized Official - Suffix:
Authorized Official - Credentials:MS, LPC
Authorized Official - Phone:209-356-8581
Mailing Address - Street 1:1821 N. CHEYENNE AVE
Mailing Address - Street 2:
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74106-4135
Mailing Address - Country:US
Mailing Address - Phone:209-356-8581
Mailing Address - Fax:
Practice Address - Street 1:3160 S. 129TH E AVE
Practice Address - Street 2:SUITE 130
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74134-3250
Practice Address - Country:US
Practice Address - Phone:918-409-0536
Practice Address - Fax:918-414-7602
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-03-08
Last Update Date:2016-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK5915101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty