Provider Demographics
NPI:1609124858
Name:BREDE, MICHAEL BENJAMIN
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:BENJAMIN
Last Name:BREDE
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1000 E 4TH AVE
Mailing Address - Street 2:
Mailing Address - City:ANCHORAGE
Mailing Address - State:AK
Mailing Address - Zip Code:99501-2716
Mailing Address - Country:US
Mailing Address - Phone:907-762-8699
Mailing Address - Fax:907-743-3033
Practice Address - Street 1:1000 E 4TH AVE
Practice Address - Street 2:
Practice Address - City:ANCHORAGE
Practice Address - State:AK
Practice Address - Zip Code:99501-2716
Practice Address - Country:US
Practice Address - Phone:907-762-8699
Practice Address - Fax:907-743-3033
Is Sole Proprietor?:No
Enumeration Date:2012-08-20
Last Update Date:2012-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health