| Breaking Grit, Llc | |
|
W10174 29th St Camp Douglas WI 54618-9709 | |
| (608) 344-0053 | |
| Not Available |
| Full Name | Breaking Grit, Llc |
|---|---|
| Speciality | Marriage & Family Therapist |
| Location | W10174 29th St, Camp Douglas, Wisconsin |
| Authorized Official Name and Position | Keyara Tabbert (JOINT OWNERSHIP) |
| Authorized Official Contact | 6083440053 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Breaking Grit, Llc W10174 29th St Camp Douglas WI 54618-9709 Ph: (608) 344-0053 | Breaking Grit, Llc W10174 29th St Camp Douglas WI 54618-9709 Ph: (608) 344-0053 |
| NPI Number | 1033921044 |
|---|---|
| Provider Enumeration Date | 01/25/2025 |
| Last Update Date | 01/25/2025 |
| Certification Date | 01/25/2025 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1033921044 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 106H00000X | Marriage & Family Therapist | (* (Not Available)) | Primary |