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General NPI Number Information
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NPI Number | 1114738846
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Entity Type | Organization
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Legal Business Name | BREITBACH THERAPEUTIC SOLUTIONS PLLC
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Dates
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Enumeration Date | 01/14/2025
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Last Update Date | 07/18/2025
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Provider Practice Location Address
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Address Line | 505 OAK ST N APT 434
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City | FARGO
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State | ND
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Zip | 58102-5542
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Country | US
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Telephone | 406-852-5801
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Fax |
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Provider Business Mailing Address
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Address Line | 505 OAK ST N APT 434
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City | FARGO
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State | ND
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Zip | 58102-5542
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Country | US
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Telephone | 406-852-5801
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | CHASE BREITBACH
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Credential | LCSW
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Telephone | 701-260-8303
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM0850X
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Taxonomy Name | Adult Mental Health Clinic/Center
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License Number |
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License Number State |
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