Healthcare Provider Details

I. General information

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

II. Dates (important events)

Enumeration Date: 09/27/2014
Last Update Date: 11/27/2021
Certification Date: 11/27/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12107 HWY 14 N
CEDAR CREST NM
87008-9461
US

IV. Provider business mailing address

12107 HIGHWAY 14 N
CEDAR CREST NM
87008-9461
US

V. Phone/Fax

Practice location:
  • Phone: 505-377-9813
  • Fax:
Mailing address:
  • Phone: 505-377-9813
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number0165061
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: