Provider Demographics
NPI:1487179925
Name:IMBER, BRIAN L (PSYCHOLOGIST, LMHC)
Entity Type:Individual
Prefix:DR
First Name:BRIAN
Middle Name:L
Last Name:IMBER
Suffix:
Gender:M
Credentials:PSYCHOLOGIST, LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6688 WATERTON CIR
Mailing Address - Street 2:
Mailing Address - City:MUKILTEO
Mailing Address - State:WA
Mailing Address - Zip Code:98275-4805
Mailing Address - Country:US
Mailing Address - Phone:425-563-3099
Mailing Address - Fax:
Practice Address - Street 1:11522 NE 21ST ST STE 100
Practice Address - Street 2:
Practice Address - City:BELLEVUE
Practice Address - State:WA
Practice Address - Zip Code:98004-3025
Practice Address - Country:US
Practice Address - Phone:206-456-5450
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-08-05
Last Update Date:2021-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALH61027314101YM0800X, 246ZE0500X
CAPSY32640246ZE0500X, 103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No246ZE0500XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherEEG