Provider Demographics
NPI:1346669611
Name:BRELAND, VICKI LYNNE (LMHC)
Entity Type:Individual
Prefix:
First Name:VICKI
Middle Name:LYNNE
Last Name:BRELAND
Suffix:
Gender:F
Credentials:LMHC
Other - Prefix:
Other - First Name:VICKI
Other - Middle Name:LYNNE
Other - Last Name:SALO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:3435 MARTIN WAY E
Mailing Address - Street 2:SUITE E
Mailing Address - City:OLYMPIA
Mailing Address - State:WA
Mailing Address - Zip Code:98506-5071
Mailing Address - Country:US
Mailing Address - Phone:360-481-2248
Mailing Address - Fax:360-456-8846
Practice Address - Street 1:3435 MARTIN WAY E
Practice Address - Street 2:SUITE E
Practice Address - City:OLYMPIA
Practice Address - State:WA
Practice Address - Zip Code:98506-5071
Practice Address - Country:US
Practice Address - Phone:360-481-2248
Practice Address - Fax:360-456-8846
Is Sole Proprietor?:No
Enumeration Date:2014-04-15
Last Update Date:2015-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALH60164817101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA2021112Medicaid