Individual
DR. THOMAS ARTHUR BREITENBUCHER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PH.D., L.P.
Contact information
Practice address
6120 EARLE BROWN DR, SUITE 520, BROOKLYN CENTER, MN 55430-2123
(763) 531-0566
(763) 531-0602
Mailing address
6120 EARLE BROWN DR, SUITE 520, BROOKLYN CENTER, MN 55430-2123
(763) 531-0566
(763) 531-0602
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
LP2794
MN
103TC0700X
Clinical Psychologist
Primary
LP2794
MN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
104654
UCARE
MN
05
—
433853700
—
MN
01
—
54R37BR
BLUECROSSBLUESHIELD
MN
01
—
61-16175
MEDICA
MN
Enumeration date
11/13/2006
Last updated
11/17/2016
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