MEDICARE: COLLEEN T BERGREN LMHC LCMHC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YM0800X	Mental Health Counselor	19165	NC

General Provider Information

NPI Number	:	1730771544
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	COLLEEN T BERGREN LMHC LCMHC

Provider Business Mailing Address
First Line	:	3650 RODGERS ROAD
Second Line	:	SUITE 306
City	:	WAKE FOREST
State	:	NC
Zip	:	27587
Country	:	US
Telephone Number	:	919-346-3360
Fax Number	:

Provider Business Practice Location Address
First Line	:	3650 RODGERS ROAD
Second Line	:	SUITE 306
City	:	WAKE FOREST
State	:	NC
Zip	:	27587
Country	:	US
Telephone Number	:	919-346-3360
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/03/2021
Last Update Date	:	04/09/2026

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