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General NPI Number Information
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NPI Number | 1306088695
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Entity Type | Individual
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Provider Name | NATHAN HENRY BERGHORST MA, MFT
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Gender | Male
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Dates
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Enumeration Date | 04/01/2009
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Last Update Date | 05/04/2012
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Provider Practice Location Address
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Address Line | 1604 FORD AVE STE 2A
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City | MODESTO
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State | CA
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Zip | 95350-4649
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Country | US
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Telephone | 209-573-1883
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Fax | 209-521-0156
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Provider Business Mailing Address
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Address Line | 935 BAKER DR
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City | RIPON
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State | CA
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Zip | 95366-2523
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Country | US
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Telephone | 209-573-1883
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Fax | 209-521-0156
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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 | 106H00000X
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Taxonomy Name | Marriage & Family Therapist
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License Number | 50812
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License Number State | CA
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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 |
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License Number State |
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