Provider Demographics
NPI:1811138175
Name:BREIKSS, DAWN M (LMHC)
Entity type:Individual
Prefix:
First Name:DAWN
Middle Name:M
Last Name:BREIKSS
Suffix:
Gender:F
Credentials:LMHC
Other - Prefix:
Other - First Name:DAWN
Other - Middle Name:M
Other - Last Name:FISHER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
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:253-302-8489
Practice Address - Street 1:4113 BRIDGEPORT WAY W
Practice Address - Street 2:STE C-1
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:253-302-8489
Is Sole Proprietor?:Yes
Enumeration Date:2009-03-17
Last Update Date:2017-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALH 60231168101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA2023189Medicaid