Organization
BREAKING FREE, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MS. TAMMY RENEA KROMHOUT (CO-OWNER)
(541) 405-4622
Entity
Organization
Contact information
Practice address
165 S MAIN ST, LEBANON, OR 97355-4223
(541) 405-4622
(541) 405-4381
Mailing address
PO BOX 24, JEFFERSON, OR 97352-0024
(541) 327-8099
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
—
—
251S00000X
Community/Behavioral Health Agency
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
500717667
—
OR
Enumeration date
04/10/2018
Last updated
03/26/2020
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