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General NPI Number Information
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NPI Number | 1578877510
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Entity Type | Individual
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Provider Name | ALICE BERGMAN LPC
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Gender | Female
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Dates
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Enumeration Date | 08/02/2010
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Last Update Date | 08/02/2010
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Provider Practice Location Address
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Address Line | 7180 SW FIR LOOP STE 1A
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City | PORTLAND
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State | OR
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Zip | 97223-8077
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Country | US
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Telephone | 503-639-3009
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Fax | 503-620-3453
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Provider Business Mailing Address
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Address Line | 7180 SW FIR LOOP STE 1A
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City | PORTLAND
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State | OR
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Zip | 97223-8077
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Country | US
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Telephone | 503-639-3009
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Fax | 503-620-3453
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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 | 101Y00000X
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Taxonomy Name | Counselor
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License Number | LPC
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License Number State | OR
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