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General NPI Number Information
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NPI Number | 1184124026
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Entity Type | Individual
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Provider Name | SHEENA MARIE BERGERON
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Gender | Female
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Dates
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Enumeration Date | 02/16/2018
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Last Update Date | 06/06/2023
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Provider Practice Location Address
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Address Line | 325 BUENA CREEK RD
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City | SAN MARCOS
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State | CA
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Zip | 92069-9679
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Country | US
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Telephone | 760-754-5500
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Fax |
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Provider Business Mailing Address
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Address Line | 552 E BARHAM DR APT 220
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City | SAN MARCOS
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State | CA
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Zip | 92078-7401
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Country | US
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Telephone | 336-508-2711
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Fax |
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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 | 101580
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | 4285
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License Number State | CA
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Taxonomy #3
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Taxonomy Code | 106H00000X
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Taxonomy Name | Marriage & Family Therapist
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License Number | 126084
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License Number State | CA
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