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General NPI Number Information
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NPI Number | 1255217998
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Entity Type | Individual
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Provider Name | JACOB BERGSTROM LPCC
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Gender | Male
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Dates
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Enumeration Date | 08/15/2025
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Last Update Date | 08/28/2025
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Provider Practice Location Address
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Address Line | 55 MADISON ST STE 240
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City | DENVER
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State | CO
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Zip | 80206-5451
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Country | US
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Telephone | 970-310-3406
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Fax |
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Provider Business Mailing Address
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Address Line | 1234 N CLARKSON ST APT 303
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City | DENVER
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State | CO
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Zip | 80218-1853
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Country | US
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Telephone | 714-797-0798
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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 | 101YA0400X
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Taxonomy Name | Addiction (Substance Use Disorder) Counselor
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License Number | ACA.0008282
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License Number State | CO
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Taxonomy #2
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | LPCC.0023748
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License Number State | CO
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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 | LPCC.0023748
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License Number State | CO
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