Provider Demographics
NPI:1992059265
Name:EADES, BREANNA E (MA, NCC, LPC)
Entity type:Individual
Prefix:MRS
First Name:BREANNA
Middle Name:E
Last Name:EADES
Suffix:
Gender:F
Credentials:MA, NCC, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:801 N WEBER ST
Mailing Address - Street 2:SUITE 103
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80903-5927
Mailing Address - Country:US
Mailing Address - Phone:719-321-5370
Mailing Address - Fax:719-532-9370
Practice Address - Street 1:801 N WEBER ST
Practice Address - Street 2:SUITE 103
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80903-5927
Practice Address - Country:US
Practice Address - Phone:719-321-5370
Practice Address - Fax:719-532-9370
Is Sole Proprietor?:Yes
Enumeration Date:2012-11-07
Last Update Date:2016-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YP2500X
CO0011896101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional