Healthcare Provider Details

I. General information

NPI: 1518685221
Provider Name (Legal Business Name): ESTELLE LAUREN BERGER M.S., QMHP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/18/2022
Last Update Date: 09/27/2024
Certification Date: 09/27/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1234 HIGH ST
EUGENE OR
97401-3238
US

IV. Provider business mailing address

1258 HIGH ST
EUGENE OR
97401-3238
US

V. Phone/Fax

Practice location:
  • Phone: 541-342-8437
  • Fax:
Mailing address:
  • Phone: 541-342-8437
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: