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General NPI Number Information
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NPI Number | 1871027250
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Entity Type | Individual
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Provider Name | SHAWN BREEDEN HS-BCP, MA
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Gender | Male
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Dates
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Enumeration Date | 04/12/2017
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Last Update Date | 04/12/2017
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Provider Practice Location Address
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Address Line | 4196 E WHITEHALL DR
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City | SAN TAN VALLEY
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State | AZ
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Zip | 85140-7647
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Country | US
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Telephone | 435-899-0751
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Fax |
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Provider Business Mailing Address
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Address Line | 4196 E WHITEHALL DR
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City | SAN TAN VALLEY
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State | AZ
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Zip | 85140-7647
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Country | US
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Telephone | 435-899-0751
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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 | 101YP1600X
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Taxonomy Name | Pastoral Counselor
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License Number |
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License Number State |
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