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General NPI Number Information
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NPI Number | 1205262722
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Entity Type | Individual
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Provider Name | DANA BRICKHAM PHD, LP, LPC, CRC
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Gender | Female
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Dates
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Enumeration Date | 09/16/2013
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Last Update Date | 03/25/2025
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Provider Practice Location Address
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Address Line | 8409 16TH ST SE
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City | LAKE STEVENS
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State | WA
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Zip | 98258-3850
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Country | US
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Telephone | 608-333-8723
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Fax |
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Provider Business Mailing Address
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Address Line | 8409 16TH ST SE
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City | LAKE STEVENS
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State | WA
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Zip | 98258-3850
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Country | US
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Telephone | 608-333-8723
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101Y00000X
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Taxonomy Name | Counselor
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License Number | 5186-125
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License Number State | WI
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Taxonomy #2
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Taxonomy Code | 225C00000X
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Taxonomy Name | Rehabilitation Counselor
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License Number | 00090487
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License Number State | WI
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Taxonomy #3
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Taxonomy Code | 103T00000X
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Taxonomy Name | Psychologist
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License Number | PY60610064
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License Number State | WA
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