Provider Demographics
NPI:1770757403
Name:BRIAN CLEMMONS COUNSELING
Entity type:Organization
Organization Name:BRIAN CLEMMONS COUNSELING
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MENTAL HEALTH THERAPIST
Authorized Official - Prefix:MR
Authorized Official - First Name:BRIAN
Authorized Official - Middle Name:W
Authorized Official - Last Name:CLEMMONS
Authorized Official - Suffix:
Authorized Official - Credentials:MA LMHC
Authorized Official - Phone:509-205-5639
Mailing Address - Street 1:603 KNIGHT ST
Mailing Address - Street 2:STE. 3
Mailing Address - City:RICHLAND
Mailing Address - State:WA
Mailing Address - Zip Code:99352-4220
Mailing Address - Country:US
Mailing Address - Phone:509-205-5639
Mailing Address - Fax:
Practice Address - Street 1:603 KNIGHT ST
Practice Address - Street 2:STE. 3
Practice Address - City:RICHLAND
Practice Address - State:WA
Practice Address - Zip Code:99352-4220
Practice Address - Country:US
Practice Address - Phone:509-205-5639
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-04-14
Last Update Date:2008-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALH00011096101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty