Healthcare Provider Details

I. General information

NPI: 1114835436
Provider Name (Legal Business Name): CORALLYN BERGER LPC-ASSOCIATE
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/28/2026
Last Update Date: 08/28/2026
Certification Date: 08/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11164 NEWTON CIR
CONROE TX
77303-3244
US

IV. Provider business mailing address

11164 NEWTON CIR
CONROE TX
77303-3244
US

V. Phone/Fax

Practice location:
  • Phone: 936-228-9259
  • Fax:
Mailing address:
  • Phone: 936-228-9259
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number103748
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: