Organization
BREAKTHROUGH SOUL EVOLUTION
Active
Organization subpart
No
Provider details
NPI number
Authorized official
CHARLIE CRAWFORD (OWNER)
(606) 219-0856
Entity
Organization
Contact information
Practice address
1340 S HIGHWAY 27 STE C, SOMERSET, KY 42501-2900
(606) 676-0123
Mailing address
1340 S HIGHWAY 27 STE C, SOMERSET, KY 42501-2900
(606) 676-0123
Taxonomy
Speciality
Code
Description
License number
State
251S00000X
Community/Behavioral Health Agency
Primary
—
—
Other
Enumeration date
01/09/2023
Last updated
01/09/2023
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