Provider Demographics
NPI:1861686008
Name:BRECKENRIDGE, ROBERT ALLEN (MFT)
Entity type:Individual
Prefix:
First Name:ROBERT
Middle Name:ALLEN
Last Name:BRECKENRIDGE
Suffix:
Gender:M
Credentials:MFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:420-B N. EL CAMINO REAL
Mailing Address - Street 2:
Mailing Address - City:OCEANSIDE
Mailing Address - State:CA
Mailing Address - Zip Code:92058-7868
Mailing Address - Country:US
Mailing Address - Phone:760-439-2273
Mailing Address - Fax:760-439-1974
Practice Address - Street 1:420-B N. EL CAMINO REAL
Practice Address - Street 2:
Practice Address - City:OCEANSIDE
Practice Address - State:CA
Practice Address - Zip Code:92058-7868
Practice Address - Country:US
Practice Address - Phone:760-439-2273
Practice Address - Fax:760-439-1974
Is Sole Proprietor?:No
Enumeration Date:2007-08-30
Last Update Date:2007-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NONE101YP1600X
CAMFC44444106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
No101YP1600XBehavioral Health & Social Service ProvidersCounselorPastoral