Healthcare Provider Details

I. General information

NPI: 1023233350
Provider Name (Legal Business Name): TOM A O'BRIEN-WILSON
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/13/2007
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

320 PACIFIC PL
MOUNT VERNON WA
98273-5463
US

IV. Provider business mailing address

1133 RAILROAD AVE
BELLINGHAM WA
98225-5055
US

V. Phone/Fax

Practice location:
  • Phone: 360-416-7546
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberLH00004186
License Number StateWA
# 2
Primary TaxonomyY
Taxonomy Code101YP1600X
TaxonomyPastoral Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: