Provider Demographics
NPI:1205289360
Name:SUNRISE PSYCHOLOGY, LLC
Entity type:Organization
Organization Name:SUNRISE PSYCHOLOGY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:THERAPIST / OWNER
Authorized Official - Prefix:
Authorized Official - First Name:DAWN
Authorized Official - Middle Name:MICHELLE
Authorized Official - Last Name:BREIKSS
Authorized Official - Suffix:
Authorized Official - Credentials:LMHC
Authorized Official - Phone:253-987-6825
Mailing Address - Street 1:4113 BRIDGEPORT WAY W
Mailing Address - Street 2:STE C1
Mailing Address - City:UNIVERSITY PLACE
Mailing Address - State:WA
Mailing Address - Zip Code:98466-4325
Mailing Address - Country:US
Mailing Address - Phone:253-987-6825
Mailing Address - Fax:253-590-0875
Practice Address - Street 1:4113 BRIDGEPORT WAY W
Practice Address - Street 2:STE C1
Practice Address - City:UNIVERSITY PLACE
Practice Address - State:WA
Practice Address - Zip Code:98466-4325
Practice Address - Country:US
Practice Address - Phone:253-987-6825
Practice Address - Fax:253-590-0875
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-07-13
Last Update Date:2016-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALH 60231168101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA2023189Medicaid