Provider Demographics
NPI:1053788588
Name:BREAKING WALLS COUNSELING
Entity type:Organization
Organization Name:BREAKING WALLS COUNSELING
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MASON
Authorized Official - Middle Name:
Authorized Official - Last Name:GALLMEYER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:317-701-3384
Mailing Address - Street 1:1079 WOODFIELD COURT
Mailing Address - Street 2:
Mailing Address - City:GREENWOOD
Mailing Address - State:IN
Mailing Address - Zip Code:46143
Mailing Address - Country:US
Mailing Address - Phone:317-701-3384
Mailing Address - Fax:317-869-4398
Practice Address - Street 1:1079 WOODFIELD CT
Practice Address - Street 2:
Practice Address - City:GREENWOOD
Practice Address - State:IN
Practice Address - Zip Code:46143-6846
Practice Address - Country:US
Practice Address - Phone:317-701-3384
Practice Address - Fax:317-869-4398
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-09-01
Last Update Date:2015-09-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN34006163A1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty