MEDICARE: DR. HEATHER DENISE BREITER

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	103TC0700X	Clinical Psychologist	31825	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	86932A	OTHER	TX	BLUE CROSS BLUE SHIELD
3	P00163676	OTHER	TX	RAIL ROAD

General Provider Information

NPI Number	:	1679511794
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. HEATHER DENISE BREITER

Provider Business Mailing Address
First Line	:	6824 GLEN MEADOW DR
Second Line	:
City	:	FORT WORTH
State	:	TX
Zip	:	76132-3734
Country	:	US
Telephone Number	:	817-370-8644
Fax Number	:

Provider Business Practice Location Address
First Line	:	2129 SKYLINE DR
Second Line	:
City	:	FORT WORTH
State	:	TX
Zip	:	76114-1924
Country	:	US
Telephone Number	:	800-257-8715
Fax Number	:	800-819-1655

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/02/2006
Last Update Date	:	02/19/2010

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Directions to “ DR. HEATHER DENISE BREITER ” Practice Location

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