Individual
BRYAN WILMOTH
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
CATC-III
Contact information
Practice address
44359 PALM ST, INDIO, CA 92201-3116
(760) 342-6616
Mailing address
1633 S VIA SALIDA, PALM SPRINGS, CA 92264-8829
(323) 868-6147
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
071604
CA
Other
Enumeration date
06/12/2017
Last updated
06/12/2017
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