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General NPI Number Information
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NPI Number | 1629089586
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Entity Type | Individual
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Provider Name | ANDREW BREEDLOVE
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Gender | Male
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Dates
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Enumeration Date | 08/10/2006
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Last Update Date | 02/10/2025
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Provider Practice Location Address
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Address Line | 5215 WHITNEY BLVD
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City | ROCKLIN
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State | CA
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Zip | 95677-2252
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Country | US
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Telephone | 916-622-6579
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Fax |
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Provider Business Mailing Address
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Address Line | 5215 WHITNEY BLVD
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City | ROCKLIN
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State | CA
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Zip | 95677-2252
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Country | US
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Telephone | 916-622-6579
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Fax | 916-632-8613
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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 |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 27174
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License Number State | CA
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