Healthcare Provider Details

I. General information

NPI: 1457754061
Provider Name (Legal Business Name): SARA BERGERT LPCC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/27/2014
Last Update Date: 05/27/2026
Certification Date: 05/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5310 HOMESTEAD RD NE STE 300
ALBUQUERQUE NM
87110-1524
US

IV. Provider business mailing address

12107 HIGHWAY 14 N
CEDAR CREST NM
87008-9461
US

V. Phone/Fax

Practice location:
  • Phone: 505-503-6838
  • Fax: 505-369-1292
Mailing address:
  • Phone: 505-377-9813
  • Fax: 505-369-1292

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberCCMH0206731
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: