| Breaking Cycles Counseling | |
|
12139 Mount Vernon Ave Ste 105 Grand Terrace CA 92313-5500 | |
| (909) 222-0096 | |
| (840) 600-3050 |
| Full Name | Breaking Cycles Counseling |
|---|---|
| Speciality | Social Worker |
| Location | 12139 Mount Vernon Ave Ste 105, Grand Terrace, California |
| Authorized Official Name and Position | Kalisha Koran Brown (CEO) |
| Authorized Official Contact | 9092220096 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Breaking Cycles Counseling 3010 S Dakota St Pine Bluff AR 71601-7208 Ph: (870) 200-9393 | Breaking Cycles Counseling 12139 Mount Vernon Ave Ste 105 Grand Terrace CA 92313-5500 Ph: (909) 222-0096 |
| NPI Number | 1972284958 |
|---|---|
| Provider Enumeration Date | 07/31/2023 |
| Last Update Date | 05/14/2026 |
| Certification Date | 05/14/2026 |
| Medicare PECOS PAC ID | 4082078027 |
|---|---|
| Medicare Enrollment ID | O20230911000920 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1972284958 | NPI | - | NPPES |
| 100393986 | Medicaid | CA |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 101YM0800X | Counselor - Mental Health | (NU) | Secondary |
| 1041C0700X | Social Worker - Clinical | (NU) | Primary |
| 261QM1300X | Clinic/center - Multi-specialty | (NU) | Secondary |
| Provider Name | Kalisha Koran Ayisha Brown |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1396307070 PECOS PAC ID: 7012313133 Enrollment ID: I20210914003840 |
| Provider Name | Janeen Bonilla |
|---|---|
| Provider Type | Practitioner - Marriage And Family Therapist |
| Provider Identifiers | NPI Number: 1083318091 PECOS PAC ID: 1052820438 Enrollment ID: I20250605002050 |
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