Healthcare Provider Details

I. General information

NPI: 1366950412
Provider Name (Legal Business Name): ADAM MARK BERTOCH MS, LCDC, LMFT-A
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/10/2018
Last Update Date: 07/09/2026
Certification Date: 07/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8350 ASHLANE WAY STE 104
SPRING TX
77382-2341
US

IV. Provider business mailing address

21723 MOSSY FIELD LN
SPRING TX
77388-3647
US

V. Phone/Fax

Practice location:
  • Phone: 832-246-8806
  • Fax:
Mailing address:
  • Phone: 281-356-3605
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number13545
License Number StateTX
# 2
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number202792
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: