Provider Demographics
NPI:1437898335
Name:BREAZEALE, CINDI LOVE
Entity Type:Individual
Prefix:
First Name:CINDI
Middle Name:LOVE
Last Name:BREAZEALE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1285 N MAIN ST STE 101-5
Mailing Address - Street 2:
Mailing Address - City:MANSFIELD
Mailing Address - State:TX
Mailing Address - Zip Code:76063-1511
Mailing Address - Country:US
Mailing Address - Phone:817-705-7170
Mailing Address - Fax:
Practice Address - Street 1:1285 N MAIN ST STE 101-5
Practice Address - Street 2:
Practice Address - City:MANSFIELD
Practice Address - State:TX
Practice Address - Zip Code:76063-1511
Practice Address - Country:US
Practice Address - Phone:817-705-7170
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-05-31
Last Update Date:2022-05-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional