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General NPI Number Information
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NPI Number | 1265631014
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Entity Type | Individual
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Provider Name | MICHAEL S. BERGMAN PH.D.
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Gender | Male
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Dates
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Enumeration Date | 07/12/2007
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Last Update Date | 07/12/2007
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Provider Practice Location Address
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Address Line | 901 NUECES ST
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City | AUSTIN
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State | TX
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Zip | 78701-2217
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Country | US
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Telephone | 512-417-2723
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Fax |
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Provider Business Mailing Address
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Address Line | 803 WEST AVE
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City | AUSTIN
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State | TX
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Zip | 78701-2207
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Country | US
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Telephone | 512-417-2723
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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 | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number | 33417
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License Number State | TX
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