Logan Denzil Breitweiser

Primary specialty

Mental Health CounselorTaxonomy code 101YM0800X

License

MC61463215 Issued in WA

Practice address

123 NW 36TH St Ste 210
Seattle, WA 98107-4959

Phone

(206) 402-5767

NPI assigned

Sep 19, 2022

Last updated

Oct 11, 2023By the provider in NPPES

Sex

Male

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 3

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: No
• Power mobility devices: No
• Hospice: No

Green means eligible to order or refer.

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Mindful Therapy Group PC

  dba Mindful Therapy Group

  • Clinical Social Worker
  • Mountlake Terrace, WA
  • NPI 1316238678

  Mental Health

  NPD

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1663545600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1696982400000",
    "number": "1174245872",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2801 E YESLER WAY APT 31",
            "city": "SEATTLE",
            "state": "WA",
            "postal_code": "981226576",
            "telephone_number": "720-989-8295"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "123 NW 36TH ST STE 210",
            "city": "SEATTLE",
            "state": "WA",
            "postal_code": "981074959",
            "telephone_number": "206-402-5767"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BREITWEISER",
        "first_name": "LOGAN",
        "middle_name": "DENZIL",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2022-09-19",
        "last_updated": "2023-10-11",
        "certification_date": "2023-10-11",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101Y00000X",
            "taxonomy_group": "",
            "desc": "Counselor",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "101YM0800X",
            "taxonomy_group": "",
            "desc": "Counselor, Mental Health",
            "state": "WA",
            "license": "MC61463215",
            "primary": true
        },
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Timothy J Brei, MD
• Heather D Breidenbach, PHARMD
• Natasha Breidenbach, LSWAIC
• David Breiger, PH.D.
• Daniella Joye Breithaupt, PA
• William John Bremner, MD
• Alexis Lee Brendible, MD
• Stephanie Brener
• Quinn Hendrick Brenfleck, MA
• Asher Brennan

• Mental Health Counselor in Seattle, WA
• Providers in Seattle, WA by specialty
• Mental Health Counselor in Washington

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 11, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.