Provider Demographics
NPI:1780418855
Name:BREAKTHROUGH BEHAVIORAL NORTH LLC
Entity type:Organization
Organization Name:BREAKTHROUGH BEHAVIORAL NORTH LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRACTICE ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:BRANDI
Authorized Official - Middle Name:
Authorized Official - Last Name:SILLANPAA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:480-525-0058
Mailing Address - Street 1:4801 S LAKESHORE DR STE 106
Mailing Address - Street 2:
Mailing Address - City:TEMPE
Mailing Address - State:AZ
Mailing Address - Zip Code:85282-7156
Mailing Address - Country:US
Mailing Address - Phone:480-525-0058
Mailing Address - Fax:480-684-3060
Practice Address - Street 1:4801 S LAKESHORE DR STE 106
Practice Address - Street 2:
Practice Address - City:TEMPE
Practice Address - State:AZ
Practice Address - Zip Code:85282-7156
Practice Address - Country:US
Practice Address - Phone:480-525-0058
Practice Address - Fax:480-684-3060
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:BREAKTHROUGH BEHAVIORAL HEALTH LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2024-08-29
Last Update Date:2024-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health