Healthcare Provider Details

I. General information

NPI: 1003629759
Provider Name (Legal Business Name): GABRI'ELLA BREEDLOVE LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/28/2025
Last Update Date: 07/13/2026
Certification Date: 07/13/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

23823 CUMBERLAND RIDGE DR APT 104
HOCKLEY TX
77447-1476
US

IV. Provider business mailing address

23823 CUMBERLAND RIDGE DR APT 104
HOCKLEY TX
77447-1476
US

V. Phone/Fax

Practice location:
  • Phone: 346-270-6087
  • Fax:
Mailing address:
  • Phone: 346-270-6087
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number108012
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: