Provider Demographics
NPI:1548709504
Name:LONGWELL, BRIANNA (LMHC, BCBA/LBA)
Entity type:Individual
Prefix:
First Name:BRIANNA
Middle Name:
Last Name:LONGWELL
Suffix:
Gender:F
Credentials:LMHC, BCBA/LBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:233 THOMPSON RD
Mailing Address - Street 2:
Mailing Address - City:SEDRO WOOLLEY
Mailing Address - State:WA
Mailing Address - Zip Code:98284-9515
Mailing Address - Country:US
Mailing Address - Phone:206-276-8670
Mailing Address - Fax:
Practice Address - Street 1:103 E HOLLY ST STE 202
Practice Address - Street 2:
Practice Address - City:BELLINGHAM
Practice Address - State:WA
Practice Address - Zip Code:98225-4728
Practice Address - Country:US
Practice Address - Phone:360-927-9556
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-02-22
Last Update Date:2020-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WABA60916078103K00000X
WALH60889173101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
Provider Identifiers
StateIdentifier IDID TypeIssuer
WALH60889173OtherMENTAL HEATH COUNSELOR
WABA60916078OtherLICENSED BEHAVIOR ANALYST