Provider Demographics
NPI:1598264855
Name:EDDY, BREELIN ASHLEY
Entity Type:Individual
Prefix:
First Name:BREELIN
Middle Name:ASHLEY
Last Name:EDDY
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 1:31559 ROSE SAGE WAY
Mailing Address - Street 2:
Mailing Address - City:MURRIETA
Mailing Address - State:CA
Mailing Address - Zip Code:92563-3319
Mailing Address - Country:US
Mailing Address - Phone:951-255-4937
Mailing Address - Fax:
Practice Address - Street 1:30804 MOONFLOWER LN
Practice Address - Street 2:
Practice Address - City:MURRIETA
Practice Address - State:CA
Practice Address - Zip Code:92563-7936
Practice Address - Country:US
Practice Address - Phone:951-325-7630
Practice Address - Fax:951-325-2585
Is Sole Proprietor?:Yes
Enumeration Date:2018-02-01
Last Update Date:2018-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CARBT-16-20813103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst