Provider Demographics
NPI:1861630170
Name:BREEDEN, KATRINA DONA' (LCMFT)
Entity Type:Individual
Prefix:
First Name:KATRINA
Middle Name:DONA'
Last Name:BREEDEN
Suffix:
Gender:F
Credentials:LCMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8911 E ORME ST STE D
Mailing Address - Street 2:
Mailing Address - City:WICHITA
Mailing Address - State:KS
Mailing Address - Zip Code:67207-2424
Mailing Address - Country:US
Mailing Address - Phone:316-425-7774
Mailing Address - Fax:316-425-7779
Practice Address - Street 1:8911 E ORME ST STE D
Practice Address - Street 2:
Practice Address - City:WICHITA
Practice Address - State:KS
Practice Address - Zip Code:67207-2424
Practice Address - Country:US
Practice Address - Phone:316-425-7774
Practice Address - Fax:316-425-7779
Is Sole Proprietor?:Yes
Enumeration Date:2009-01-23
Last Update Date:2019-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS1023101YM0800X
KS909106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health