Healthcare Provider Details

I. General information

NPI: 1235372590
Provider Name (Legal Business Name): SHERENE ALETTA BERGHOFF N.C.C., L.P.C.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/15/2009
Last Update Date: 04/15/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1015 E 760 N
OREM UT
84097-5479
US

IV. Provider business mailing address

1015 E 760 N
OREM UT
84097-5479
US

V. Phone/Fax

Practice location:
  • Phone: 801-921-9232
  • Fax: 801-765-0088
Mailing address:
  • Phone: 801-921-9232
  • Fax: 801-765-0088

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number4949223-6004
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: