Organization
BREAKTHROUGH COUNSELING LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. GARY T. EVANS PHD (CLINICAL DIRECTOR)
(573) 426-2588
Entity
Organization
Contact information
Practice address
901 N. PINE STREET, SUITE 101, ROLLA, MO 65401-3181
(573) 426-2588
(573) 426-4859
Mailing address
901 N. PINE STREET, SUITE 101, ROLLA, MO 65401-3181
(573) 426-2588
(573) 426-4859
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
003819
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
$$$$$$$$$
GARY EVANS SSN
MO
Enumeration date
12/28/2006
Last updated
08/22/2020
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