Provider Demographics
NPI:1225680986
Name:BREITMEYER, NATALIE R (LCPC, R-DMT)
Entity Type:Individual
Prefix:
First Name:NATALIE
Middle Name:R
Last Name:BREITMEYER
Suffix:
Gender:F
Credentials:LCPC, R-DMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1641 S MILLER ST
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60608-2311
Mailing Address - Country:US
Mailing Address - Phone:206-949-2892
Mailing Address - Fax:
Practice Address - Street 1:1641 S MILLER ST
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60608-2311
Practice Address - Country:US
Practice Address - Phone:773-217-0746
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-07-12
Last Update Date:2024-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL180.013989101YP2500X
IL178.014230101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101Y00000XBehavioral Health & Social Service ProvidersCounselor