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General NPI Number Information
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NPI Number | 1245249747
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Entity Type | Individual
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Provider Name | CYNTHIA BERGSTROM DEVLIN L.P.C.C., L.M.F.T.
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Gender | Female
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Dates
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Enumeration Date | 08/05/2006
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Last Update Date | 07/21/2022
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Provider Practice Location Address
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Address Line | 1229 S SAINT FRANCIS DR STE B
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City | SANTA FE
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State | NM
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Zip | 87505-4052
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Country | US
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Telephone | 505-303-3586
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Fax | 505-303-3586
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Provider Business Mailing Address
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Address Line | 6 BUENA VENTURA PL
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City | SANTA FE
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State | NM
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Zip | 87508-8377
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Country | US
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Telephone | 505-303-3586
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Fax | 505-303-3586
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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 | 0189951
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License Number State | NM
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Taxonomy #2
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Taxonomy Code | 106H00000X
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Taxonomy Name | Marriage & Family Therapist
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License Number | 0189901
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License Number State | NM
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Taxonomy #3
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | 0189951
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License Number State | NM
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