MEDICARE: KATIE C BERGMAN LMHC, MC

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	PPC-863	WY
2	101YM0800X	Mental Health Counselor	MH17204	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1245635788
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KATIE C BERGMAN LMHC, MC

Provider Business Mailing Address
First Line	:	2581 HUNTCLIFF LN
Second Line	:
City	:	PANAMA CITY
State	:	FL
Zip	:	32405-4902
Country	:	US
Telephone Number	:	850-520-3321
Fax Number	:	850-848-6490

Provider Business Practice Location Address
First Line	:	2581 HUNTCLIFF LN
Second Line	:
City	:	PANAMA CITY
State	:	FL
Zip	:	32405-4902
Country	:	US
Telephone Number	:	850-520-3321
Fax Number	:	850-848-6490

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

Provider Enumeration Date	:	10/27/2014
Last Update Date	:	03/22/2024

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Directions to “ KATIE C BERGMAN LMHC, MC” Practice Location

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