Provider Demographics
NPI:1619592870
Name:BREEDLOVE, EDWARD WEST (LPC-MHSP, MACMH)
Entity type:Individual
Prefix:MR
First Name:EDWARD
Middle Name:WEST
Last Name:BREEDLOVE
Suffix:
Gender:M
Credentials:LPC-MHSP, MACMH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:41 EAST CT
Mailing Address - Street 2:
Mailing Address - City:RINGGOLD
Mailing Address - State:GA
Mailing Address - Zip Code:30736-5591
Mailing Address - Country:US
Mailing Address - Phone:423-930-9030
Mailing Address - Fax:
Practice Address - Street 1:3069 BROAD ST STE 7D
Practice Address - Street 2:
Practice Address - City:CHATTANOOGA
Practice Address - State:TN
Practice Address - Zip Code:37408-3083
Practice Address - Country:US
Practice Address - Phone:423-517-7070
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-06-13
Last Update Date:2025-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101Y00000X
TN7702101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101Y00000XBehavioral Health & Social Service ProvidersCounselor