Provider Demographics
NPI:1871027250
Name:BREEDEN, SHAWN (HS-BCP, MA)
Entity Type:Individual
Prefix:
First Name:SHAWN
Middle Name:
Last Name:BREEDEN
Suffix:
Gender:M
Credentials:HS-BCP, MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4196 E WHITEHALL DR
Mailing Address - Street 2:
Mailing Address - City:SAN TAN VALLEY
Mailing Address - State:AZ
Mailing Address - Zip Code:85140-7647
Mailing Address - Country:US
Mailing Address - Phone:435-899-0751
Mailing Address - Fax:
Practice Address - Street 1:4196 E WHITEHALL DR
Practice Address - Street 2:
Practice Address - City:SAN TAN VALLEY
Practice Address - State:AZ
Practice Address - Zip Code:85140-7647
Practice Address - Country:US
Practice Address - Phone:435-899-0751
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-04-12
Last Update Date:2017-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP1600XBehavioral Health & Social Service ProvidersCounselorPastoral