Healthcare Provider Details

I. General information

NPI: 1205262722
Provider Name (Legal Business Name): DANA BRICKHAM PHD, LP, LPC, CRC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/16/2013
Last Update Date: 03/25/2025
Certification Date: 03/25/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8409 16TH ST SE
LAKE STEVENS WA
98258-3850
US

IV. Provider business mailing address

8409 16TH ST SE
LAKE STEVENS WA
98258-3850
US

V. Phone/Fax

Practice location:
  • Phone: 608-333-8723
  • Fax:
Mailing address:
  • Phone: 608-333-8723
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number5186-125
License Number StateWI
# 2
Primary TaxonomyN
Taxonomy Code225C00000X
TaxonomyRehabilitation Counselor
License Number00090487
License Number StateWI
# 3
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License NumberPY60610064
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: