Provider Demographics
NPI:1265588255
Name:BRINKMAN, DANIEL DALE (PSYD)
Entity type:Individual
Prefix:DR
First Name:DANIEL
Middle Name:DALE
Last Name:BRINKMAN
Suffix:
Gender:M
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 331
Mailing Address - Street 2:
Mailing Address - City:LYNDEN
Mailing Address - State:WA
Mailing Address - Zip Code:98264-0331
Mailing Address - Country:US
Mailing Address - Phone:360-398-8127
Mailing Address - Fax:360-354-5399
Practice Address - Street 1:1610 GROVER ST
Practice Address - Street 2:SUITE D-1
Practice Address - City:LYNDEN
Practice Address - State:WA
Practice Address - Zip Code:98264-1539
Practice Address - Country:US
Practice Address - Phone:360-398-8127
Practice Address - Fax:360-354-5399
Is Sole Proprietor?:No
Enumeration Date:2007-01-25
Last Update Date:2022-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPY00001993103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
P26389Medicare UPIN
WAG8858018Medicare PIN