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General NPI Number Information
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NPI Number | 1548419609
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Entity Type | Individual
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Provider Name | KENNETH EUGENE BREEDING PH.D., MFT
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Gender | Male
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Dates
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Enumeration Date | 09/13/2008
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Last Update Date | 09/13/2008
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Provider Practice Location Address
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Address Line | 3150 EL CAMINO REAL SUITE E
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City | CARLSBAD
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State | CA
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Zip | 92008-2110
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Country | US
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Telephone | 760-434-2423
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Fax | 760-434-9482
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Provider Business Mailing Address
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Address Line | 4314 STANFORD ST
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City | CARLSBAD
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State | CA
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Zip | 92010-7922
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Country | US
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Telephone | 760-434-2423
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Fax | 760-434-9482
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 106H00000X
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Taxonomy Name | Marriage & Family Therapist
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License Number | MFC 22083
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License Number State | CA
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