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General NPI Number Information
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NPI Number | 1568258457
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Entity Type | Organization
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Legal Business Name | BERGDAHL ASSESSMENT & PSYCHOTHERAPY, PLLC
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Dates
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Enumeration Date | 04/16/2025
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Last Update Date | 08/22/2025
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Provider Practice Location Address
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Address Line | 530 S ASBURY ST STE 4A
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City | MOSCOW
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State | ID
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Zip | 83843-2243
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Country | US
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Telephone | 208-310-2266
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Fax | 888-830-7441
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Provider Business Mailing Address
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Address Line | 2254 WESTVIEW DR
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City | MOSCOW
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State | ID
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Zip | 83843-9623
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Country | US
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Telephone | 559-288-1747
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Fax |
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Authorized Official
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Title or Position | CLINICAL PSYCHOLOGIST
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Name | DR. STEPHEN A BERGDAHL
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Credential | PHD
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Telephone | 559-288-1747
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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 |
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License Number State |
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