Healthcare Provider Details

I. General information

NPI: 1699287318
Provider Name (Legal Business Name): BREELYND EGGLESTON M.ED., LMHC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/03/2017
Last Update Date: 11/03/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

236 EAST MAIN STREET
RICHFIELD SPRINGS NY
13439
US

IV. Provider business mailing address

PO BOX 569
RICHFIELD SPRINGS NY
13439-0569
US

V. Phone/Fax

Practice location:
  • Phone: 315-219-6722
  • Fax:
Mailing address:
  • Phone: 315-219-6722
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number006015-1
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number006015-1
License Number StateNY
# 3
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number006015-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: