Active NPI
Bryan Wilmoth, CATC-III
- Addiction (Substance Use Disorder) Counselor
- Indio, CA
National Provider Identifier
1063942142
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Addiction (Substance Use Disorder) Counselor
- License
- 071604
- Practice address
- 44359 Palm St
Indio, CA 92201-3116 - Phone
- (760) 342-6616
- NPI assigned
- Jun 12, 2017
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Addiction (Substance Use Disorder) Counselor | 101YA0400X | 071604 | CA | Primary |
Addresses
Primary practice location
44359 Palm St
Indio, CA 92201-3116
Mailing address
1633 S Via Salida
Palm Springs, CA 92264-8829
Phone (323) 868-6147
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 071604 | CA | MD | Addiction (Substance Use Disorder) Counselor |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1497225600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1497225600000",
"number": "1063942142",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1633 S VIA SALIDA",
"city": "PALM SPRINGS",
"state": "CA",
"postal_code": "922648829",
"telephone_number": "323-868-6147"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "44359 PALM ST",
"city": "INDIO",
"state": "CA",
"postal_code": "922013116",
"telephone_number": "760-342-6616"
}
],
"practiceLocations": [],
"basic": {
"last_name": "WILMOTH",
"first_name": "BRYAN",
"credential": "CATC-III",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2017-06-12",
"last_updated": "2017-06-12",
"status": "A"
},
"taxonomies": [
{
"code": "101YA0400X",
"taxonomy_group": "",
"desc": "Counselor, Addiction (Substance Use Disorder)",
"state": "CA",
"license": "071604",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Indio, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 12, 2017; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.