Individual
BRYAN WILLSON-KO
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
1520 TRAMWAY BLVD NE, ALBUQUERQUE, NM 87112-4655
(505) 266-6121
Mailing address
2308 SE 40TH AVE, PORTLAND, OR 97214-5922
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
—
—
Other
Enumeration date
06/01/2021
Last updated
06/01/2021
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