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General NPI Number Information
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NPI Number | 1780546135
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Entity Type | Individual
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Provider Name | SAMANTHA DARLYNN BREEDLOVE
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Gender | Female
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Dates
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Enumeration Date | 11/24/2025
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Last Update Date | 11/24/2025
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Provider Practice Location Address
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Address Line | 2923 NE BROADWAY ST
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City | PORTLAND
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State | OR
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Zip | 97232-1760
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Country | US
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Telephone | 503-208-5566
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Fax |
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Provider Business Mailing Address
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Address Line | 5303 SE 66TH AVE
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City | PORTLAND
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State | OR
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Zip | 97206-5301
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Country | US
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Telephone | 661-972-4922
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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 | 106H00000X
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Taxonomy Name | Marriage & Family Therapist
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License Number | 14133306-3902
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License Number State | UT
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Taxonomy #2
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Taxonomy Code | 106H00000X
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Taxonomy Name | Marriage & Family Therapist
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License Number | 136378
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License Number State | CA
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Taxonomy #3
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | C10643
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License Number State | OR
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