Provider Demographics
NPI:1265979991
Name:HENNESS, BRITTANY ALYSON (CP61021166, LH608799)
Entity type:Individual
Prefix:MRS
First Name:BRITTANY
Middle Name:ALYSON
Last Name:HENNESS
Suffix:
Gender:F
Credentials:CP61021166, LH608799
Other - Prefix:MS
Other - First Name:BRITTANY
Other - Middle Name:ALYSON
Other - Last Name:BOULTON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CP61021166, LH608799
Mailing Address - Street 1:916 MARIE PL
Mailing Address - Street 2:
Mailing Address - City:SEDRO WOOLLEY
Mailing Address - State:WA
Mailing Address - Zip Code:98284-9322
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:916 MARIE PL
Practice Address - Street 2:
Practice Address - City:SEDRO WOOLLEY
Practice Address - State:WA
Practice Address - Zip Code:98284-9322
Practice Address - Country:US
Practice Address - Phone:818-307-3574
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-01-19
Last Update Date:2021-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA60611968101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional