Provider Demographics
NPI:1265509749
Name:STILWELL, BRIAN K (MFT)
Entity Type:Individual
Prefix:MR
First Name:BRIAN
Middle Name:K
Last Name:STILWELL
Suffix:
Gender:M
Credentials:MFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3134 WILLOW AVE STE 103
Mailing Address - Street 2:
Mailing Address - City:CLOVIS
Mailing Address - State:CA
Mailing Address - Zip Code:93612-4747
Mailing Address - Country:US
Mailing Address - Phone:559-970-7739
Mailing Address - Fax:
Practice Address - Street 1:3134 WILLOW AVE STE 103
Practice Address - Street 2:
Practice Address - City:CLOVIS
Practice Address - State:CA
Practice Address - Zip Code:93612-4747
Practice Address - Country:US
Practice Address - Phone:559-970-7739
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-29
Last Update Date:2012-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC 28751106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist