| Douglas A. Bergstrom, Ph.d., Pllc | |
|
143 E Merritt St Prescott AZ 86301-2028 | |
| (928) 445-3835 | |
| (928) 445-7071 |
| Full Name | Douglas A. Bergstrom, Ph.d., Pllc |
|---|---|
| Speciality | Community/Behavioral Health |
| Location | 143 E Merritt St, Prescott, Arizona |
| Authorized Official Name and Position | Douglas Alan Bergstrom (PSYCHOLOGIST) |
| Authorized Official Contact | 9284453835 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Douglas A. Bergstrom, Ph.d., Pllc 143 E Merritt St Prescott AZ 86301-2028 Ph: (928) 445-3835 | Douglas A. Bergstrom, Ph.d., Pllc 143 E Merritt St Prescott AZ 86301-2028 Ph: (928) 445-3835 |
| NPI Number | 1154501682 |
|---|---|
| Provider Enumeration Date | 11/13/2007 |
| Last Update Date | 11/13/2007 |
| Medicare PECOS PAC ID | 2860581816 |
|---|---|
| Medicare Enrollment ID | O20071129000057 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1154501682 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 251S00000X | Community/behavioral Health | 1142 (Arizona) | Primary |
| Provider Name | Douglas A Bergstrom |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1063536688 PECOS PAC ID: 9931134327 Enrollment ID: I20051005000081 |
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