MEDICARE: DR. BRIAN L IMBER PSYCHOLOGIST, LMHC

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	101YM0800X	Mental Health Counselor	LH61027314	WA
2	246ZE0500X	EEG Specialist/Technologist	LH61027314	WA
3	246ZE0500X	EEG Specialist/Technologist	PSY32640	CA
4	103TC0700X	Clinical Psychologist	PSY32640	CA

General Provider Information

NPI Number	:	1487179925
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. BRIAN L IMBER PSYCHOLOGIST, LMHC

Provider Business Mailing Address
First Line	:	6688 WATERTON CIR
Second Line	:
City	:	MUKILTEO
State	:	WA
Zip	:	98275-4805
Country	:	US
Telephone Number	:	425-563-3099
Fax Number	:

Provider Business Practice Location Address
First Line	:	11522 NE 21ST ST STE 100
Second Line	:
City	:	BELLEVUE
State	:	WA
Zip	:	98004-3025
Country	:	US
Telephone Number	:	206-456-5450
Fax Number	:

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

Provider Enumeration Date	:	08/05/2017
Last Update Date	:	09/12/2021

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