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General NPI Number Information
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NPI Number | 1659794113
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Entity Type | Individual
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Provider Name | MARCIA GHALI BERGREN
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Gender | Female
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Dates
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Enumeration Date | 02/03/2014
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Last Update Date | 12/19/2018
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Provider Practice Location Address
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Address Line | 1812 N 169TH PLZ
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City | OMAHA
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State | NE
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Zip | 68118-2809
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Country | US
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Telephone | 402-934-1617
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Fax | 402-834-5225
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Provider Business Mailing Address
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Address Line | 2031 N 62ND ST
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City | OMAHA
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State | NE
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Zip | 68104-4705
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Country | US
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Telephone |
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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 | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 1685
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License Number State | NE
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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 | 1547
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License Number State | NE
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