MEDICARE: BERGER FAMILY THERAPY, PROFESSIONAL CORPORATION

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YP2500X	Professional Counselor
2	106H00000X	Marriage & Family Therapist

General Provider Information

NPI Number	:	1033075924
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BERGER FAMILY THERAPY, PROFESSIONAL CORPORATION

Provider Business Mailing Address
First Line	:	1525 LAUREL LN
Second Line	:
City	:	SAN LUIS OBISPO
State	:	CA
Zip	:	93401-4642
Country	:	US
Telephone Number	:	805-295-9954
Fax Number	:	805-457-8218

Provider Business Practice Location Address
First Line	:	1428 PHILLIPS LN STE 202
Second Line	:
City	:	SAN LUIS OBISPO
State	:	CA
Zip	:	93401-2567
Country	:	US
Telephone Number	:	805-441-2954
Fax Number	:	805-457-8218

Authorized Official
Title or Position	:	OWNER
Name	:	DR. KRISTINA HIBSHMAN BERGER
Credential	:	LMFT, LPCC
Telephone Number	:	805-441-2954

Provider Enumeration Date	:	01/05/2026
Last Update Date	:	04/07/2026

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