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General NPI Number Information
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NPI Number | 1619592870
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Entity Type | Individual
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Provider Name | EDWARD WEST BREEDLOVE LPC-MHSP, MACMH
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Gender | Male
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Dates
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Enumeration Date | 06/13/2020
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Last Update Date | 10/29/2025
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Provider Practice Location Address
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Address Line | 243 SIGNAL MOUNTAIN RD STE 131
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City | CHATTANOOGA
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State | TN
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Zip | 37405-1933
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Country | US
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Telephone | 423-930-9030
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Fax |
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Provider Business Mailing Address
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Address Line | 41 EAST CT
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City | RINGGOLD
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State | GA
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Zip | 30736-5591
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Country | US
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Telephone | 423-930-9030
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Fax |
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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 | 101Y00000X
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Taxonomy Name | Counselor
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | 7702
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License Number State | TN
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