Provider Demographics
NPI:1245775899
Name:WILLBUR, MIKE ALLEN (LMHC)
Entity Type:Individual
Prefix:MR
First Name:MIKE
Middle Name:ALLEN
Last Name:WILLBUR
Suffix:
Gender:M
Credentials:LMHC
Other - Prefix:MR
Other - First Name:MIKE
Other - Middle Name:ALLEN
Other - Last Name:WILLBUR
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LMHC
Mailing Address - Street 1:14804 NE 16TH ST
Mailing Address - Street 2:
Mailing Address - City:VANCOUVER
Mailing Address - State:WA
Mailing Address - Zip Code:98684-3600
Mailing Address - Country:US
Mailing Address - Phone:360-241-3448
Mailing Address - Fax:888-896-6082
Practice Address - Street 1:14804 NE 16TH ST
Practice Address - Street 2:
Practice Address - City:VANCOUVER
Practice Address - State:WA
Practice Address - Zip Code:98684-3600
Practice Address - Country:US
Practice Address - Phone:360-241-3448
Practice Address - Fax:888-896-6082
Is Sole Proprietor?:Yes
Enumeration Date:2017-01-05
Last Update Date:2017-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALH60640788101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health