MEDICARE: MRS. CHERYL SUE BERGE LMFT

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	MFC 30703	CA

General Provider Information

NPI Number	:	1609916907
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. CHERYL SUE BERGE LMFT

Provider Business Mailing Address
First Line	:	PO BOX 1342
Second Line	:
City	:	MAGALIA
State	:	CA
Zip	:	95954-1342
Country	:	US
Telephone Number	:	530-624-2473
Fax Number	:

Provider Business Practice Location Address
First Line	:	15 ILAHEE LN STE 100
Second Line	:
City	:	CHICO
State	:	CA
Zip	:	95973-7205
Country	:	US
Telephone Number	:	530-624-2473
Fax Number	:

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

Provider Enumeration Date	:	02/07/2007
Last Update Date	:	09/20/2018

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