Individual provider Active NPI

Nicole Renee Breesnee, CDP

  • Counselor
  • Spokane, WA
National Provider Identifier
1760953384
Registry record updated Jul 9, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
CounselorTaxonomy code 101Y00000X
License
CO60709233 Issued in WA
Practice address
2308 W. 3Rd Ave
Spokane, WA 99201
Phone
(509) 624-1244
Fax
(509) 624-6240
NPI assigned
Dec 7, 2018
Last updated
Jul 9, 2019By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 9, 2019

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Counselor 101Y00000X CO60709233 WA Primary

Addresses

Primary practice location

2308 W. 3Rd Ave
Spokane, WA 99201

Mailing address

12715 E Mission Ave
Spokane Valley, WA 99216-1027
Phone (509) 232-5766

Other identifiers 1

IdentifierTypeStateIssuer
2077844MedicaidWA

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Not enrolled

State licenses

LicenseStateTypeSpecialty
CO60709233WAMDCounselor

Practice roles

OrganizationSpecialtyStatusNew patients
New Horizon Care Centers, Inc. Past Accepting new patients
New Horizon Care Center, Inc. Past Accepting new patients
American Behavioral Health Systems, Inc. Past Accepting new patients
American Behavioral Health Systems, Inc. Past Accepting new patients

Organizations & group practices 4

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.

NPI Registry JSON

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

{
    "created_epoch": "1544140800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1562630400000",
    "number": "1760953384",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "12715 E MISSION AVE",
            "city": "SPOKANE VALLEY",
            "state": "WA",
            "postal_code": "992161027",
            "telephone_number": "509-232-5766",
            "fax_number": "509-321-5472"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2308 W. 3RD AVE",
            "city": "SPOKANE",
            "state": "WA",
            "postal_code": "99201",
            "telephone_number": "509-624-1244",
            "fax_number": "509-624-6240"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BREESNEE",
        "first_name": "NICOLE",
        "middle_name": "RENEE",
        "credential": "CDP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2018-12-07",
        "last_updated": "2019-07-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101Y00000X",
            "taxonomy_group": "",
            "desc": "Counselor",
            "state": "WA",
            "license": "CO60709233",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "2077844",
            "state": "WA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Spokane, WA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 9, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.