Provider Demographics
NPI:1619592870
Name:BREEDLOVE, EDWARD WEST (MA)
Entity Type:Individual
Prefix:MR
First Name:EDWARD
Middle Name:WEST
Last Name:BREEDLOVE
Suffix:
Gender:M
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3069 BROAD ST STE 7D
Mailing Address - Street 2:
Mailing Address - City:CHATTANOOGA
Mailing Address - State:TN
Mailing Address - Zip Code:37408-3083
Mailing Address - Country:US
Mailing Address - Phone:423-517-7070
Mailing Address - Fax:
Practice Address - Street 1:3069 BROAD ST STE 7D
Practice Address - Street 2:
Practice Address - City:CHATTANOOGA
Practice Address - State:TN
Practice Address - Zip Code:37408-3083
Practice Address - Country:US
Practice Address - Phone:423-517-7070
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-06-13
Last Update Date:2020-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor