Provider Demographics
NPI:1992782015
Name:CRESTVIEW PSYCHOLOGICAL SERVICES, P.S.
Entity type:Organization
Organization Name:CRESTVIEW PSYCHOLOGICAL SERVICES, P.S.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:DANIEL
Authorized Official - Middle Name:DALE
Authorized Official - Last Name:BRINKMAN
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD
Authorized Official - Phone:360-398-8127
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:360-398-8217
Practice Address - Fax:360-354-5399
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-12-29
Last Update Date:2022-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPY00001993103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
P26389Medicare UPIN
8858017Medicare ID - Type Unspecified