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1063942142
BRYAN WILMOTH
INDIO, CA
NPI
1063942142
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Entity Type
Individual
Gender
Male
Sole Proprietor ?
No
Primary Taxonomy
101YA0400X Counselor, Addiction (Substance Use Disorder)
(Licence: CA 071604)
Enumeration Date
2017-06-12
Last Update Date
2017-06-12
Business Address
BRYAN WILMOTH CATC-III
44359 PALM ST
INDIO, CA 92201-3116
Phone number: 760-342-6616
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Mailing Address
BRYAN WILMOTH CATC-III
1633 S VIA SALIDA
PALM SPRINGS, CA 92264-8829
Phone number: 323-868-6147
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