Provider Demographics
NPI:1447871827
Name:AMANDA BREEDEN COUNSELING SERVICES LLC
Entity type:Organization
Organization Name:AMANDA BREEDEN COUNSELING SERVICES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:THERAPIST/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:AMANDA
Authorized Official - Middle Name:FAY
Authorized Official - Last Name:BREEDEN
Authorized Official - Suffix:
Authorized Official - Credentials:LCPC
Authorized Official - Phone:309-340-1363
Mailing Address - Street 1:5901 N PROSPECT RD STE 105
Mailing Address - Street 2:
Mailing Address - City:PEORIA
Mailing Address - State:IL
Mailing Address - Zip Code:61614-4358
Mailing Address - Country:US
Mailing Address - Phone:309-340-1363
Mailing Address - Fax:309-417-7719
Practice Address - Street 1:5901 N PROSPECT RD STE 105
Practice Address - Street 2:
Practice Address - City:PEORIA
Practice Address - State:IL
Practice Address - Zip Code:61614-4358
Practice Address - Country:US
Practice Address - Phone:309-340-1363
Practice Address - Fax:309-417-7719
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-04-27
Last Update Date:2020-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty