Individual
MR. IAN THOMSON BRECKENRIDGE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
LPC
Contact information
Practice address
1642 WOODS MILL DR, WENTZVILLE, MO 63385-2629
(314) 442-5320
Mailing address
1642 WOODS MILL DR, WENTZVILLE, MO 63385-2629
(314) 442-5320
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
2017044140
MO
Other
Enumeration date
10/20/2022
Last updated
10/20/2022
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