Provider Demographics
NPI:1235532334
Name:DAHLBERG, DAN A (LMHC)
Entity type:Individual
Prefix:
First Name:DAN
Middle Name:A
Last Name:DAHLBERG
Suffix:
Gender:M
Credentials:LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:709 FRONT STREET
Mailing Address - Street 2:
Mailing Address - City:LYNDEN
Mailing Address - State:WA
Mailing Address - Zip Code:98264-1819
Mailing Address - Country:US
Mailing Address - Phone:360-820-0593
Mailing Address - Fax:360-685-8338
Practice Address - Street 1:709 FRONT STREET
Practice Address - Street 2:
Practice Address - City:LYNDEN
Practice Address - State:WA
Practice Address - Zip Code:98264-1819
Practice Address - Country:US
Practice Address - Phone:360-820-0593
Practice Address - Fax:360-685-8338
Is Sole Proprietor?:Yes
Enumeration Date:2014-10-02
Last Update Date:2025-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALH60562079101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA2302285Medicaid