Provider Demographics
NPI:1235359365
Name:WOOLLEY, BRIAN WIRT
Entity Type:Individual
Prefix:MR
First Name:BRIAN
Middle Name:WIRT
Last Name:WOOLLEY
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9989 VISTA DEL VALLE
Mailing Address - Street 2:
Mailing Address - City:DESERT HOT SPRINGS
Mailing Address - State:CA
Mailing Address - Zip Code:92240-1750
Mailing Address - Country:US
Mailing Address - Phone:760-770-2222
Mailing Address - Fax:
Practice Address - Street 1:68615 PEREZ RD
Practice Address - Street 2:
Practice Address - City:CATHEDRAL CITY
Practice Address - State:CA
Practice Address - Zip Code:92234-7200
Practice Address - Country:US
Practice Address - Phone:760-770-2222
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health