Provider Demographics
NPI:1770280158
Name:KREMBS, BRIAN J (MA, MED, LMHCA)
Entity type:Individual
Prefix:
First Name:BRIAN
Middle Name:J
Last Name:KREMBS
Suffix:
Gender:M
Credentials:MA, MED, LMHCA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:137 VISTA WAY
Mailing Address - Street 2:
Mailing Address - City:FRIDAY HARBOR
Mailing Address - State:WA
Mailing Address - Zip Code:98250-8469
Mailing Address - Country:US
Mailing Address - Phone:360-317-3286
Mailing Address - Fax:
Practice Address - Street 1:137 VISTA WAY
Practice Address - Street 2:
Practice Address - City:FRIDAY HARBOR
Practice Address - State:WA
Practice Address - Zip Code:98250-8469
Practice Address - Country:US
Practice Address - Phone:360-317-3286
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-02-15
Last Update Date:2023-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA61348659101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA61348659OtherDEPARTMENT OF HEALTH