Provider Demographics
NPI:1487795688
Name:BREDA, CHERIE RENEE (PHD)
Entity type:Individual
Prefix:
First Name:CHERIE
Middle Name:RENEE
Last Name:BREDA
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:CHERIE
Other - Middle Name:BREDA
Other - Last Name:HARRIS
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PHD
Mailing Address - Street 1:19731 E PIKES PEAK CT
Mailing Address - Street 2:SUITE 202
Mailing Address - City:PARKER
Mailing Address - State:CO
Mailing Address - Zip Code:80138-7401
Mailing Address - Country:US
Mailing Address - Phone:314-225-7695
Mailing Address - Fax:303-841-6571
Practice Address - Street 1:19731 E PIKES PEAK CT
Practice Address - Street 2:SUITE 202
Practice Address - City:PARKER
Practice Address - State:CO
Practice Address - Zip Code:80138-7401
Practice Address - Country:US
Practice Address - Phone:314-225-7695
Practice Address - Fax:303-841-6571
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-09
Last Update Date:2015-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO3621103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical