NPI | 1114492956 |
---|---|
Former Name | MARY ELIZABETH BERGENS |
Entity Type | Individual |
Gender | Female |
Sole Proprietor ? | Yes |
Primary Taxonomy | 106H00000X Marriage & Family Therapist (Licence: MS T0510) |
Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: MS T0510) |
171M00000X Case Manager/Care Coordinator (Licence: MS T0510) | |
251B00000X Case Management (Licence: MS T0510) | |
Enumeration Date | 2018-10-08 |
Last Update Date | 2025-01-12 |