Provider Demographics
NPI:1346824596
Name:BREAZEALE, CINDA RENEE (MS, LMFT, LCDC)
Entity Type:Individual
Prefix:
First Name:CINDA
Middle Name:RENEE
Last Name:BREAZEALE
Suffix:
Gender:F
Credentials:MS, LMFT, LCDC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9636 MILLRIDGE CIR
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75243-6115
Mailing Address - Country:US
Mailing Address - Phone:214-621-2294
Mailing Address - Fax:
Practice Address - Street 1:10300 N CENTRAL EXPY STE 220
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75231-8626
Practice Address - Country:US
Practice Address - Phone:972-884-5923
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-05-12
Last Update Date:2024-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX5175101YA0400X
TX202501106H00000X
106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Multi-Specialty
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Multi-Specialty