Provider Demographics
NPI:1154202141
Name:BRINKMAN, THERESA DAGONDON
Entity type:Individual
Prefix:
First Name:THERESA
Middle Name:DAGONDON
Last Name:BRINKMAN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4984 EL CAMINO REAL STE 208
Mailing Address - Street 2:
Mailing Address - City:LOS ALTOS
Mailing Address - State:CA
Mailing Address - Zip Code:94022-1433
Mailing Address - Country:US
Mailing Address - Phone:650-297-3400
Mailing Address - Fax:
Practice Address - Street 1:4984 EL CAMINO REAL STE 208
Practice Address - Street 2:
Practice Address - City:LOS ALTOS
Practice Address - State:CA
Practice Address - Zip Code:94022-1433
Practice Address - Country:US
Practice Address - Phone:650-297-3400
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-09-08
Last Update Date:2025-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA157305106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist