Healthcare Provider Details

I. General information

NPI: 1386257111
Provider Name (Legal Business Name): EMILY BREEDLOVE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/31/2020
Last Update Date: 09/21/2026
Certification Date: 09/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11673 JOLLYVILLE RD STE 201
AUSTIN TX
78759-4211
US

IV. Provider business mailing address

14001 MACQUARIE DR
PFLUGERVILLE TX
78660-6370
US

V. Phone/Fax

Practice location:
  • Phone: 512-572-5916
  • Fax: 737-358-4271
Mailing address:
  • Phone: 512-909-2041
  • Fax: 737-358-4271

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number79532
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: