Provider Demographics
NPI:1205262722
Name:BRICKHAM, DANA (PHD, LP, LPC, CRC)
Entity type:Individual
Prefix:DR
First Name:DANA
Middle Name:
Last Name:BRICKHAM
Suffix:
Gender:
Credentials:PHD, LP, LPC, CRC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8409 16TH ST SE
Mailing Address - Street 2:
Mailing Address - City:LAKE STEVENS
Mailing Address - State:WA
Mailing Address - Zip Code:98258-3850
Mailing Address - Country:US
Mailing Address - Phone:608-333-8723
Mailing Address - Fax:
Practice Address - Street 1:8409 16TH ST SE
Practice Address - Street 2:
Practice Address - City:LAKE STEVENS
Practice Address - State:WA
Practice Address - Zip Code:98258-3850
Practice Address - Country:US
Practice Address - Phone:608-333-8723
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-09-16
Last Update Date:2025-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI5186-125101Y00000X
WI00090487225C00000X
WAPY60610064103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
No101Y00000XBehavioral Health & Social Service ProvidersCounselor
No225C00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRehabilitation Counselor