Provider Demographics
NPI:1518284801
Name:BRECKENRIDGE, JYE L (MSW, LISW-S)
Entity Type:Individual
Prefix:MR
First Name:JYE
Middle Name:L
Last Name:BRECKENRIDGE
Suffix:
Gender:M
Credentials:MSW, LISW-S
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3400 N HIGH ST
Mailing Address - Street 2:SUITE 120
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43202-1142
Mailing Address - Country:US
Mailing Address - Phone:614-282-1818
Mailing Address - Fax:614-358-0218
Practice Address - Street 1:3400 N HIGH ST
Practice Address - Street 2:SUITE 120
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43202-1142
Practice Address - Country:US
Practice Address - Phone:614-282-1818
Practice Address - Fax:614-358-0218
Is Sole Proprietor?:Yes
Enumeration Date:2010-04-26
Last Update Date:2013-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHI.0800068-SUPV1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical