Repairer of the Breach Counseling and Consultant Services, LLC

Primary specialty

Mental Health CounselorTaxonomy code 101YM0800X

Legal business name

REPAIRER OF THE BREACH COUNSELING AND CONSULTANT SERVICES, LLC

Practice address

319 Chandler St
Detroit, MI 48202-2857

Phone

(313) 451-4239

NPI assigned

Jan 11, 2019

Organization subpart

No

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

Authorized official

Name

Mrs. Yvonne Brooks, LCSW

Title

Lead Clinician

Phone

(313) 451-4239

Specialties & licenses 4

Addresses

Other identifiers 1

Locations

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

{
    "created_epoch": "1547164800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1673481600000",
    "number": "1922571041",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "319 CHANDLER ST",
            "city": "DETROIT",
            "state": "MI",
            "postal_code": "482022857",
            "telephone_number": "313-451-4239"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "319 CHANDLER ST",
            "city": "DETROIT",
            "state": "MI",
            "postal_code": "482022857",
            "telephone_number": "313-451-4239"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "REPAIRER OF THE BREACH COUNSELING AND CONSULTANT SERVICES, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2019-01-11",
        "last_updated": "2023-01-12",
        "certification_date": "2023-01-12",
        "status": "A",
        "authorized_official_last_name": "BROOKS",
        "authorized_official_first_name": "YVONNE",
        "authorized_official_title_or_position": "LEAD CLINICIAN",
        "authorized_official_telephone_number": "313-451-4239",
        "authorized_official_name_prefix": "Mrs.",
        "authorized_official_credential": "LCSW"
    },
    "taxonomies": [
        {
            "code": "101YM0800X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Counselor, Mental Health",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "251S00000X",
            "taxonomy_group": "",
            "desc": "Community/Behavioral Health",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "261QM0850X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Adult Mental Health",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "261QM0855X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Adolescent and Children Mental Health",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "NPI",
            "identifier": "1184962763",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 12, 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.