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General NPI Number Information
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NPI Number | 1083002455
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Entity Type | Individual
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Provider Name | CHRISTEN BERGERON MS
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Gender | Female
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Dates
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Enumeration Date | 01/07/2015
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Last Update Date | 01/07/2015
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Provider Practice Location Address
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Address Line | 1132 28TH AVE S SUITE 102
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City | MOORHEAD
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State | MN
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Zip | 56560-4420
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Country | US
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Telephone | 218-422-6119
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Fax | 218-227-5377
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Provider Business Mailing Address
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Address Line | 1132 28TH AVE S SUITE 102
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City | MOORHEAD
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State | MN
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Zip | 56560-4420
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Country | US
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Telephone | 218-422-6119
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Fax | 218-227-5377
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | 1625
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License Number State | MN
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