Provider Demographics
NPI:1699503441
Name:WHELAN, BRIAN KENDALL (LMHCA)
Entity type:Individual
Prefix:
First Name:BRIAN
Middle Name:KENDALL
Last Name:WHELAN
Suffix:
Gender:M
Credentials:LMHCA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:20670 MAINLAND VIEW LN NE
Mailing Address - Street 2:
Mailing Address - City:SUQUAMISH
Mailing Address - State:WA
Mailing Address - Zip Code:98392-9742
Mailing Address - Country:US
Mailing Address - Phone:360-689-3313
Mailing Address - Fax:
Practice Address - Street 1:20670 MAINLAND VIEW LN NE
Practice Address - Street 2:
Practice Address - City:SUQUAMISH
Practice Address - State:WA
Practice Address - Zip Code:98392-9742
Practice Address - Country:US
Practice Address - Phone:360-689-3313
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-07-23
Last Update Date:2024-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMC61550819101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health