Provider Demographics
NPI:1699455485
Name:GULLIKSEN, BRANDI LYNN (CADC-R)
Entity type:Individual
Prefix:
First Name:BRANDI
Middle Name:LYNN
Last Name:GULLIKSEN
Suffix:
Gender:F
Credentials:CADC-R
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8940 SE 72ND AVE
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97206-9417
Mailing Address - Country:US
Mailing Address - Phone:503-722-4110
Mailing Address - Fax:503-713-5990
Practice Address - Street 1:8940 SE 72ND AVE
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97206-9417
Practice Address - Country:US
Practice Address - Phone:503-722-4110
Practice Address - Fax:503-413-5990
Is Sole Proprietor?:No
Enumeration Date:2023-07-18
Last Update Date:2023-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORT-23-2826101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)