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General NPI Number Information
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NPI Number | 1215458138
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Entity Type | Organization
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Legal Business Name | JULIE BERGAN COUNSELING LLC
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Dates
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Enumeration Date | 06/30/2017
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Last Update Date | 10/09/2019
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Provider Practice Location Address
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Address Line | 313 S 3RD ST
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City | GOSHEN
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State | IN
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Zip | 46526-3709
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Country | US
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Telephone | 574-535-0880
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Fax |
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Provider Business Mailing Address
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Address Line | 412 AUDITORIUM BLVD
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City | WINONA LAKE
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State | IN
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Zip | 46590-1064
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Country | US
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Telephone | 574-269-5829
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Fax |
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Authorized Official
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Title or Position | CLINICAL SOCIAL WORKER
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Name | MRS. JULIE ELIZABETH BERGAN
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Credential | MSW, LCSW
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Telephone | 574-269-5829
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM0801X
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Taxonomy Name | Mental Health Clinic/Center (Including Community Mental Health Center)
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License Number | 34007808A
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License Number State | IN
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