MEDICARE: DR. DANA BRICKHAM PHD, LP, LPC, CRC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101Y00000X	Counselor	5186-125	WI
2	225C00000X	Rehabilitation Counselor	00090487	WI
3	103T00000X	Psychologist	PY60610064	WA

General Provider Information

NPI Number	:	1205262722
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. DANA BRICKHAM PHD, LP, LPC, CRC

Provider Business Mailing Address
First Line	:	8409 16TH ST SE
Second Line	:
City	:	LAKE STEVENS
State	:	WA
Zip	:	98258-3850
Country	:	US
Telephone Number	:	608-333-8723
Fax Number	:

Provider Business Practice Location Address
First Line	:	8409 16TH ST SE
Second Line	:
City	:	LAKE STEVENS
State	:	WA
Zip	:	98258-3850
Country	:	US
Telephone Number	:	608-333-8723
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/16/2013
Last Update Date	:	03/25/2025

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