Breaking Boulders Counseling LLC

Primary specialty

Mental Health Clinic/Center (Including Community Mental Health Center)Taxonomy code 261QM0801X

Legal business name

BREAKING BOULDERS COUNSELING LLC

Practice address

W1302 N Dam Rd
Hardwood, MI 49834-9218

Phone

(414) 617-9362

NPI assigned

May 15, 2023

Last updated

May 15, 2023By the provider in NPPES

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Aunastasia Zsidiewicz, LICSWA, MSWNPI 1689142085

Title

Mental Health Therapist/Owner

Phone

(414) 617-9362

Specialties & licenses 1

Addresses

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Aunastasia Fantasia Marie Zsidiewicz, LICSWA, AAC, CADC I

  • Clinical Social Worker
  • Warrenton, OR
  • NPI 1689142085
  NPD Authorized official

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1684108800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1684108800000",
    "number": "1093405805",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 174",
            "city": "FELCH",
            "state": "MI",
            "postal_code": "498310174",
            "telephone_number": "414-617-9362"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "W1302 N DAM RD",
            "city": "HARDWOOD",
            "state": "MI",
            "postal_code": "498349218",
            "telephone_number": "414-617-9362"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BREAKING BOULDERS COUNSELING LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2023-05-15",
        "last_updated": "2023-05-15",
        "certification_date": "2023-05-14",
        "status": "A",
        "authorized_official_last_name": "ZSIDIEWICZ",
        "authorized_official_first_name": "AUNASTASIA",
        "authorized_official_title_or_position": "MENTAL HEALTH THERAPIST/OWNER",
        "authorized_official_telephone_number": "414-617-9362",
        "authorized_official_credential": "LICSWA, MSW"
    },
    "taxonomies": [
        {
            "code": "261QM0801X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Mental Health (Including Community Mental Health Center)",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 15, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.