Provider Demographics
NPI:1851060644
Name:WILMOR, BRIANNE KATHLEEN
Entity Type:Individual
Prefix:
First Name:BRIANNE
Middle Name:KATHLEEN
Last Name:WILMOR
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:510 N J ST APT 3
Mailing Address - Street 2:
Mailing Address - City:TACOMA
Mailing Address - State:WA
Mailing Address - Zip Code:98403-2053
Mailing Address - Country:US
Mailing Address - Phone:619-599-3344
Mailing Address - Fax:
Practice Address - Street 1:510 N J ST APT 3
Practice Address - Street 2:
Practice Address - City:TACOMA
Practice Address - State:WA
Practice Address - Zip Code:98403-2053
Practice Address - Country:US
Practice Address - Phone:619-599-3344
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-09-07
Last Update Date:2021-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WACG61200322101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health