Provider Demographics
NPI:1073658464
Name:BREEDEN, JANET (LCSW)
Entity Type:Individual
Prefix:
First Name:JANET
Middle Name:
Last Name:BREEDEN
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 2727
Mailing Address - Street 2:
Mailing Address - City:GREAT FALLS
Mailing Address - State:MT
Mailing Address - Zip Code:59403-2727
Mailing Address - Country:US
Mailing Address - Phone:406-899-5171
Mailing Address - Fax:406-727-3172
Practice Address - Street 1:410 CENTRAL AVE
Practice Address - Street 2:SUITE # 502
Practice Address - City:GREAT FALLS
Practice Address - State:MT
Practice Address - Zip Code:59401-3154
Practice Address - Country:US
Practice Address - Phone:406-727-3152
Practice Address - Fax:406-727-3172
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-21
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT4111041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MT0500531Medicaid