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General NPI Number Information
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NPI Number | 1588858112
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Entity Type | Individual
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Provider Name | LORI JEAN BREEDEN L.M.F.T.
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Gender | Female
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Dates
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Enumeration Date | 08/28/2007
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Last Update Date | 08/28/2007
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Provider Practice Location Address
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Address Line | 3815 W OLIVE AVE SUITE 102
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City | BURBANK
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State | CA
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Zip | 91505-4648
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Country | US
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Telephone | 323-646-7187
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Fax | 213-483-2499
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Provider Business Mailing Address
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Address Line | 3815 W OLIVE AVE SUITE 102
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City | BURBANK
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State | CA
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Zip | 91505-4648
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Country | US
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Telephone | 323-646-7187
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Fax | 213-483-2499
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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 | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | MFT39950
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License Number State | CA
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