Provider Demographics
NPI:1396433942
Name:BREESE, NEIL MATTHEW
Entity type:Individual
Prefix:
First Name:NEIL
Middle Name:MATTHEW
Last Name:BREESE
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 1:908 THISTLE CIR
Mailing Address - Street 2:
Mailing Address - City:ALLEN
Mailing Address - State:TX
Mailing Address - Zip Code:75002-8680
Mailing Address - Country:US
Mailing Address - Phone:469-235-9211
Mailing Address - Fax:
Practice Address - Street 1:1221 ABRAMS RD STE 326
Practice Address - Street 2:
Practice Address - City:RICHARDSON
Practice Address - State:TX
Practice Address - Zip Code:75081-5574
Practice Address - Country:US
Practice Address - Phone:972-638-7199
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-05-01
Last Update Date:2023-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX87229101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional