Provider Demographics
NPI:1508192287
Name:BREEDEN, MONTA ANNETTE (LCSW LMT)
Entity type:Individual
Prefix:MS
First Name:MONTA
Middle Name:ANNETTE
Last Name:BREEDEN
Suffix:
Gender:F
Credentials:LCSW LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7024 RHODES AVENUE
Mailing Address - Street 2:
Mailing Address - City:ST. LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63123
Mailing Address - Country:US
Mailing Address - Phone:615-239-9562
Mailing Address - Fax:270-798-8224
Practice Address - Street 1:650 JOEL DR
Practice Address - Street 2:
Practice Address - City:FORT CAMPBELL
Practice Address - State:KY
Practice Address - Zip Code:42223-5318
Practice Address - Country:US
Practice Address - Phone:270-798-8400
Practice Address - Fax:270-798-8224
Is Sole Proprietor?:No
Enumeration Date:2009-10-30
Last Update Date:2024-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2022049235225700000X
MO005085104100000X
KYKY-3190101YP2500X, 104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
No225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional