MEDICARE: LINDSAY D BERGIN LPC

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	101Y00000X	Counselor	65250	TX
2	101YM0800X	Mental Health Counselor	65250	TX
3	101YP2500X	Professional Counselor	65250	TX

General Provider Information

NPI Number	:	1902177827
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LINDSAY D BERGIN LPC

Provider Business Mailing Address
First Line	:	500 THROCKMORTON ST
Second Line	:	SUITE 2212
City	:	FORT WORTH
State	:	TX
Zip	:	76102-3708
Country	:	US
Telephone Number	:	817-729-5587
Fax Number	:

Provider Business Practice Location Address
First Line	:	500 THROCKMORTON ST
Second Line	:	SUITE 2212
City	:	FORT WORTH
State	:	TX
Zip	:	76102-3708
Country	:	US
Telephone Number	:	817-729-5587
Fax Number	:

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

Provider Enumeration Date	:	01/24/2012
Last Update Date	:	01/24/2012

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