MEDICARE: BERGER & BERGER, PHDS, PC

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	367	TX
2	103TC0700X	Clinical Psychologist	2-3297	TX

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
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1669517728
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BERGER & BERGER, PHDS, PC

Provider Business Mailing Address
First Line	:	11551 FOREST CENTRAL DR
Second Line	:	123
City	:	DALLAS
State	:	TX
Zip	:	75243-3920
Country	:	US
Telephone Number	:	214-692-5793
Fax Number	:	214-368-7311

Provider Business Practice Location Address
First Line	:	11551 FOREST CENTRAL DR
Second Line	:	123
City	:	DALLAS
State	:	TX
Zip	:	75243-3920
Country	:	US
Telephone Number	:	214-692-5793
Fax Number	:	214-368-7311

Authorized Official
Title or Position	:	TREASURER
Name	:	DR. MURRAY J BERGER
Credential	:	PHD
Telephone Number	:	214-692-5793

Provider Enumeration Date	:	02/20/2007
Last Update Date	:	11/24/2009

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