Healthcare Provider Details

I. General information

NPI: 1306605233
Provider Name (Legal Business Name): TYLER M BREEDING
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/14/2024
Last Update Date: 04/08/2026
Certification Date: 04/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

660 S MAIN ST
DAYTON OH
45402-2708
US

IV. Provider business mailing address

4998 W BROAD ST STE 104
COLUMBUS OH
43228-1647
US

V. Phone/Fax

Practice location:
  • Phone: 937-269-6252
  • Fax:
Mailing address:
  • Phone: 614-754-8051
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License NumberCDCAPRE.195382
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code175T00000X
TaxonomyPeer Specialist
License NumberAPS.004700
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: