Provider Demographics
NPI:1669659900
Name:CLEMMONS, BRIAN W (MA LMHC)
Entity Type:Individual
Prefix:
First Name:BRIAN
Middle Name:W
Last Name:CLEMMONS
Suffix:
Gender:M
Credentials:MA LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8797 W GAGE BLVD STE C204
Mailing Address - Street 2:
Mailing Address - City:KENNEWICK
Mailing Address - State:WA
Mailing Address - Zip Code:99336-7194
Mailing Address - Country:US
Mailing Address - Phone:509-205-5639
Mailing Address - Fax:
Practice Address - Street 1:8797 W GAGE BLVD STE C204
Practice Address - Street 2:
Practice Address - City:KENNEWICK
Practice Address - State:WA
Practice Address - Zip Code:99336-7194
Practice Address - Country:US
Practice Address - Phone:509-205-5639
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-01-29
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALH00011096101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health