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General NPI Number Information
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NPI Number | 1750662649
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Entity Type | Individual
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Provider Name | DALONDRIC RACEL BERGEN SR. LCPC
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Gender | Male
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Dates
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Enumeration Date | 09/06/2011
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Last Update Date | 03/10/2020
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Provider Practice Location Address
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Address Line | 2013 24TH ST W APT 1
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City | BILLINGS
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State | MT
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Zip | 59102-2839
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Country | US
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Telephone | 406-899-9941
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Fax |
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Provider Business Mailing Address
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Address Line | 804 HILLVIEW LN
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City | BILLINGS
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State | MT
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Zip | 59101-5409
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Country | US
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Telephone | 432-207-0420
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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 | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number |
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License Number State |
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