Healthcare Provider Details

I. General information

NPI: 1578101473
Provider Name (Legal Business Name): BRADI BERGESEN COUNSELING PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/11/2019
Last Update Date: 04/13/2022
Certification Date: 04/13/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1653 TOWNE RD
SEQUIM WA
98382-8867
US

IV. Provider business mailing address

1653 TOWNE RD
SEQUIM WA
98382-8867
US

V. Phone/Fax

Practice location:
  • Phone: 360-209-7680
  • Fax: 360-326-1143
Mailing address:
  • Phone: 360-209-7680
  • Fax: 360-326-1143

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
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: BRADI BERGESEN
Title or Position: PRESIDENT
Credential:
Phone: 360-209-7680