Provider Demographics
NPI:1548419609
Name:BREEDING, KENNETH EUGENE (PHD, MFT)
Entity Type:Individual
Prefix:DR
First Name:KENNETH
Middle Name:EUGENE
Last Name:BREEDING
Suffix:
Gender:M
Credentials:PHD, MFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4314 STANFORD ST
Mailing Address - Street 2:
Mailing Address - City:CARLSBAD
Mailing Address - State:CA
Mailing Address - Zip Code:92010-7922
Mailing Address - Country:US
Mailing Address - Phone:760-434-2423
Mailing Address - Fax:760-434-9482
Practice Address - Street 1:3150 EL CAMINO REAL
Practice Address - Street 2:SUITE E
Practice Address - City:CARLSBAD
Practice Address - State:CA
Practice Address - Zip Code:92008-2110
Practice Address - Country:US
Practice Address - Phone:760-434-2423
Practice Address - Fax:760-434-9482
Is Sole Proprietor?:Yes
Enumeration Date:2008-09-13
Last Update Date:2008-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC 22083106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist