Provider Demographics
NPI:1912310079
Name:BREITENBACH, CYNTHIA (LCAC)
Entity Type:Individual
Prefix:
First Name:CYNTHIA
Middle Name:
Last Name:BREITENBACH
Suffix:
Gender:F
Credentials:LCAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2201 SE 25TH ST
Mailing Address - Street 2:
Mailing Address - City:TOPEKA
Mailing Address - State:KS
Mailing Address - Zip Code:66605-1734
Mailing Address - Country:US
Mailing Address - Phone:785-267-0561
Mailing Address - Fax:785-267-0573
Practice Address - Street 1:2201 SE 25TH ST
Practice Address - Street 2:
Practice Address - City:TOPEKA
Practice Address - State:KS
Practice Address - Zip Code:66605-1734
Practice Address - Country:US
Practice Address - Phone:785-267-0561
Practice Address - Fax:785-267-0573
Is Sole Proprietor?:No
Enumeration Date:2014-06-06
Last Update Date:2014-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS166101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS100106710 SMedicaid