Ian Thomson Breckenridge, LPC

Primary specialty

Mental Health CounselorTaxonomy code 101YM0800X

License

2017044140 Issued in MO

Practice address

1642 Woods Mill Dr
Wentzville, MO 63385-2629

Phone

(314) 442-5320

NPI assigned

Oct 20, 2022

Last updated

Oct 20, 2022By 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 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

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

{
    "created_epoch": "1666224000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1666224000000",
    "number": "1811614803",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1642 WOODS MILL DR",
            "city": "WENTZVILLE",
            "state": "MO",
            "postal_code": "633852629",
            "telephone_number": "314-442-5320"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1642 WOODS MILL DR",
            "city": "WENTZVILLE",
            "state": "MO",
            "postal_code": "633852629",
            "telephone_number": "314-442-5320"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "5336 Main St",
            "address_purpose": "LOCATION",
            "city": "Cottleville",
            "state": "MO",
            "postal_code": "633048002",
            "country_code": "US",
            "telephone_number": "314-442-5320",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "1611 Highway W",
            "address_purpose": "LOCATION",
            "city": "Foristell",
            "state": "MO",
            "postal_code": "633481016",
            "country_code": "US",
            "telephone_number": "314-442-5320",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "BRECKENRIDGE",
        "first_name": "IAN",
        "middle_name": "THOMSON",
        "name_prefix": "Mr.",
        "credential": "LPC",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2022-10-20",
        "last_updated": "2022-10-20",
        "certification_date": "2022-10-20",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YM0800X",
            "taxonomy_group": "",
            "desc": "Counselor, Mental Health",
            "state": "MO",
            "license": "2017044140",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Mental Health Counselor in Wentzville, MO
• Providers in Wentzville, MO by specialty
• Mental Health Counselor in Missouri

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 20, 2022; 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.