Provider Demographics
NPI:1114371341
Name:BRINKMANN, ANA-LYS (BA, QMHA)
Entity Type:Individual
Prefix:MS
First Name:ANA-LYS
Middle Name:
Last Name:BRINKMANN
Suffix:
Gender:F
Credentials:BA, QMHA
Other - Prefix:MRS
Other - First Name:ANA-LYS
Other - Middle Name:
Other - Last Name:EVANS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:182 W. ACADEMY ST.
Mailing Address - Street 2:ACADEMY BUILDING, SUITE 333
Mailing Address - City:DALLAS
Mailing Address - State:OR
Mailing Address - Zip Code:97338-0569
Mailing Address - Country:US
Mailing Address - Phone:503-623-9289
Mailing Address - Fax:503-831-1726
Practice Address - Street 1:182 SW ACADEMY ST
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:OR
Practice Address - Zip Code:97338
Practice Address - Country:US
Practice Address - Phone:503-623-9289
Practice Address - Fax:503-831-1726
Is Sole Proprietor?:No
Enumeration Date:2016-04-13
Last Update Date:2019-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101Y00000XBehavioral Health & Social Service ProvidersCounselor
Provider Identifiers
StateIdentifier IDID TypeIssuer
U56595317 04OtherCIGNA