Healthcare Provider Details

I. General information

NPI: 1093994394
Provider Name (Legal Business Name): DONALD GREGORY BERCH PHD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/02/2007
Last Update Date: 11/02/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2806 S US HIGHWAY 1
FORT PIERCE FL
34982-8109
US

IV. Provider business mailing address

4500 W MIDWAY RD
FORT PIERCE FL
34981-4823
US

V. Phone/Fax

Practice location:
  • Phone: 772-467-3052
  • Fax: 772-429-2029
Mailing address:
  • Phone: 772-468-5600
  • Fax: 772-429-2029

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number1637
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: