Basic Information
| Provider Information | |||||||||
| NPI: | 1144506080 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | LINDBERG | ||||||||
| FirstName: | BRENT | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | PH. D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 15311 NE 13TH CIR | ||||||||
| Address2: | |||||||||
| City: | VANCOUVER | ||||||||
| State: | WA | ||||||||
| PostalCode: | 986843644 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3602545793 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 7507 NE 51ST ST | ||||||||
| Address2: | |||||||||
| City: | VANCOUVER | ||||||||
| State: | WA | ||||||||
| PostalCode: | 986626007 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3609061190 | ||||||||
| FaxNumber: | 3609061193 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/24/2011 | ||||||||
| LastUpdateDate: | 10/24/2011 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 103TC0700X | PY60232138 | WA | Y | Behavioral Health & Social Service Providers | Psychologist | Clinical |
No ID Information.