| Break Repair Heal | |
|
501 Eisenhower Dr Crestview FL 32539-6955 | |
| (850) 634-8465 | |
| Not Available |
| Full Name | Break Repair Heal |
|---|---|
| Speciality | Counselor |
| Location | 501 Eisenhower Dr, Crestview, Florida |
| Authorized Official Name and Position | Danielle Wrencher (CEO) |
| Authorized Official Contact | 8506348465 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Break Repair Heal 2821 S Ferdon Blvd # 1010 Crestview FL 32536-8474 Ph: () - | Break Repair Heal 501 Eisenhower Dr Crestview FL 32539-6955 Ph: (850) 634-8465 |
| NPI Number | 1972297414 |
|---|---|
| Provider Enumeration Date | 06/07/2023 |
| Last Update Date | 06/22/2023 |
| Certification Date | 06/22/2023 |
| Medicare PECOS PAC ID | 6103264718 |
|---|---|
| Medicare Enrollment ID | O20240402001653 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1972297414 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 101YM0800X | Counselor - Mental Health | (* (Not Available)) | Primary |
| Provider Name | Danielle Jacquae Wrencher |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1609437383 PECOS PAC ID: 7911345525 Enrollment ID: I20240402001868 |
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