Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 101YM0800X | Mental Health Counselor | LH00004186 | WA |
N | 101YP1600X | Pastoral Counselor |
NPI | 1023233350 |
---|---|
Provider Name | Tom A O'brien-Wilson |
First Address | Bellingham, WA 98225-5055 |
Second Address | Mount Vernon, WA 98273-5463 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 13/04/2007 |
Last Update Date | 08/07/2007 |