MEDICARE: ADAM MARK BERTOCH MS, LCDC, LMFT-A

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	106H00000X	Marriage & Family Therapist	202792	TX
2	101YA0400X	Addiction (Substance Use Disorder) Counselor	13545	TX

General Provider Information

NPI Number	:	1366950412
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ADAM MARK BERTOCH MS, LCDC, LMFT-A

Provider Business Mailing Address
First Line	:	21723 MOSSY FIELD LN
Second Line	:
City	:	SPRING
State	:	TX
Zip	:	77388-3647
Country	:	US
Telephone Number	:	281-356-3605
Fax Number	:

Provider Business Practice Location Address
First Line	:	8350 ASHLANE WAY STE 104
Second Line	:
City	:	SPRING
State	:	TX
Zip	:	77382-2341
Country	:	US
Telephone Number	:	832-246-8806
Fax Number	:

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

Provider Enumeration Date	:	01/10/2018
Last Update Date	:	01/10/2018

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