Provider Demographics
NPI:1417060021
Name:LINDBERG, BRYAN E (LMFT)
Entity Type:Individual
Prefix:
First Name:BRYAN
Middle Name:E
Last Name:LINDBERG
Suffix:
Gender:M
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:223 S MAIN ST
Mailing Address - Street 2:
Mailing Address - City:GALAX
Mailing Address - State:VA
Mailing Address - Zip Code:24333-3911
Mailing Address - Country:US
Mailing Address - Phone:276-233-6368
Mailing Address - Fax:
Practice Address - Street 1:223 S MAIN ST
Practice Address - Street 2:
Practice Address - City:GALAX
Practice Address - State:VA
Practice Address - Zip Code:24333-3911
Practice Address - Country:US
Practice Address - Phone:276-233-6368
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-16
Last Update Date:2022-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0717001080106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA004945298Medicaid
VA176486OtherANTHEM BLUE CROSS
VA176488OtherANTHEM BLUE CROSS