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NPI Code Detail

MEDICARE: MRS. VIRGINIA BERGSTROM LMFT

MEDICARE: MRS. VIRGINIA BERGSTROM 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
1101YM0800XMental Health CounselorLMFT39596CA

General Provider Information

NPI Number : 1609929900
Entity Type Code : Individual
Provider Name (Legal Business Name) : MRS. VIRGINIA BERGSTROM LMFT
Provider Business Mailing Address
First Line : 5588 N PALM AVE
Second Line :
City : FRESNO
State : CA
Zip : 93704-1913
Country : US
Telephone Number : 559-440-0980
Fax Number : 559-440-0982
Provider Business Practice Location Address
First Line : 5588 N PALM AVE
Second Line :
City : FRESNO
State : CA
Zip : 93704-1913
Country : US
Telephone Number : 559-440-0980
Fax Number : 559-440-0982
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 01/19/2007
Last Update Date : 07/08/2007

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Directions to “ MRS. VIRGINIA BERGSTROM LMFT” Practice Location

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