Provider Demographics
NPI:1306953807
Name:WILCOX, BRIAN B (LCMHC)
Entity type:Individual
Prefix:
First Name:BRIAN
Middle Name:B
Last Name:WILCOX
Suffix:
Gender:M
Credentials:LCMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:69 BRYAN POND RD
Mailing Address - Street 2:
Mailing Address - City:MORRISVILLE
Mailing Address - State:VT
Mailing Address - Zip Code:05661-9123
Mailing Address - Country:US
Mailing Address - Phone:802-888-8462
Mailing Address - Fax:
Practice Address - Street 1:56 TWIN OAKS TER
Practice Address - Street 2:
Practice Address - City:SOUTH BURLINGTON
Practice Address - State:VT
Practice Address - Zip Code:05403-7167
Practice Address - Country:US
Practice Address - Phone:802-847-3333
Practice Address - Fax:802-847-1424
Is Sole Proprietor?:No
Enumeration Date:2006-08-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT068-0000514101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
VT1007522Medicaid
VTOTH000Medicare UPIN