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General NPI Number Information
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NPI Number | 1366950412
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Entity Type | Individual
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Provider Name | ADAM MARK BERTOCH MS, LCDC, LMFT-A
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Gender | Male
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Dates
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Enumeration Date | 01/10/2018
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Last Update Date | 01/10/2018
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Provider Practice Location Address
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Address Line | 8350 ASHLANE WAY STE 104
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City | SPRING
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State | TX
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Zip | 77382-2341
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Country | US
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Telephone | 832-246-8806
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Fax |
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Provider Business Mailing Address
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Address Line | 21723 MOSSY FIELD LN
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City | SPRING
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State | TX
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Zip | 77388-3647
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Country | US
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Telephone | 281-356-3605
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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 | 106H00000X
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Taxonomy Name | Marriage & Family Therapist
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License Number | 202792
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License Number State | TX
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Taxonomy #2
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Taxonomy Code | 101YA0400X
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Taxonomy Name | Addiction (Substance Use Disorder) Counselor
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License Number | 13545
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License Number State | TX
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