MEDICARE: EMILY DIANE BERGSTROM LPC

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	101YM0800X	Mental Health Counselor	LPC-6167	ID

General Provider Information

NPI Number	:	1184254146
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	EMILY DIANE BERGSTROM LPC

Provider Business Mailing Address
First Line	:	2365 N 34TH ST
Second Line	:
City	:	BOISE
State	:	ID
Zip	:	83703-5523
Country	:	US
Telephone Number	:	208-473-8205
Fax Number	:

Provider Business Practice Location Address
First Line	:	2365 N 34TH ST
Second Line	:
City	:	BOISE
State	:	ID
Zip	:	83703-5523
Country	:	US
Telephone Number	:	208-473-8205
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/18/2020
Last Update Date	:	01/18/2020

Similar Medicare Providers

1811491756 — ANDREW JOHNSON MD
Practice Location Address:

419 S 8TH ST STE 303
BOISE, ID
83702-5523

Practice Phone: 208-241-7475
Practice Fax: 208-847-7005

1669328001 — COURTNEY GABBERT
Practice Location Address:

6001 W STATE ST STE C
BOISE, ID
83703-6428

Practice Phone: 208-996-0828
Practice Fax:

1255287264 — JAMES WALSH
Practice Location Address:

3663 N LAKEHARBOR LN
BOISE, ID
83703-6913

Practice Phone: 208-261-9948
Practice Fax:

1093662934 — SHANE BENDTSEN
Practice Location Address:

4745 N CASTLE HILLS AVE
BOISE, ID
83703-2765

Practice Phone: 208-626-4805
Practice Fax:

1366399008 — KACIE MICHELLE STEVENS
Practice Location Address:

3663 N LAKEHARBOR LN
BOISE, ID
83703-6913

Practice Phone: 208-650-7359
Practice Fax:

1073460614 — CATHERINE JEANIENE ELLIOTT LPC
Practice Location Address:

4227 N TAMARACK DR
BOISE, ID
83703-4031

Practice Phone: 208-724-4773
Practice Fax:

Directions to “ EMILY DIANE BERGSTROM LPC” Practice Location

Language	Start Address	Practice Location

These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

Copyright © 2007-2026 (Powered by Swiss Vault Engine), all rights reserved. HIPAA liability, trademark, document use and software licensing rules apply. All registered trademarks, used in the content, are the property of their owners. Your interactions with this site are in accordance with our Terms of Use and Privacy Policy.