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General NPI Number Information
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NPI Number | 1184043168
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Entity Type | Organization
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Legal Business Name | BECKY BERGTHOLD, LLC
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Dates
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Enumeration Date | 04/07/2014
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Last Update Date | 04/07/2014
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Provider Practice Location Address
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Address Line | 1702 N COLLINS BLVD SUITE 190
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City | RICHARDSON
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State | TX
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Zip | 75080-3566
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Country | US
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Telephone | 214-693-7646
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Fax |
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Provider Business Mailing Address
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Address Line | 1702 N COLLINS BLVD SUITE 190
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City | RICHARDSON
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State | TX
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Zip | 75080-3566
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Country | US
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Telephone | 214-693-7646
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Fax |
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Authorized Official
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Title or Position | CHILD AND ADOLESCENT THERAPIST
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Name | REBECCA L BERGTHOLD
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Credential | MS, LPC
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Telephone | 214-693-7646
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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 | 17987
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License Number State | TX
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