Provider Demographics
NPI:1235353491
Name:BREEDING, TERESA L (LCSW)
Entity Type:Individual
Prefix:MS
First Name:TERESA
Middle Name:L
Last Name:BREEDING
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 1:9338 ARBAN DR
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63126-2157
Mailing Address - Country:US
Mailing Address - Phone:314-842-6242
Mailing Address - Fax:
Practice Address - Street 1:ST. VINCENT HOME FOR CHILDREN
Practice Address - Street 2:7401 FLORRISANT RD.
Practice Address - City:ST. LOUIS,
Practice Address - State:MO
Practice Address - Zip Code:63121
Practice Address - Country:US
Practice Address - Phone:314-261-6011
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical