Provider Demographics
NPI:1083307375
Name:BERTA, WILLIAM (LCDCI)
Entity Type:Individual
Prefix:
First Name:WILLIAM
Middle Name:
Last Name:BERTA
Suffix:
Gender:M
Credentials:LCDCI
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4700 S RIVERSIDE DR
Mailing Address - Street 2:
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76119-5523
Mailing Address - Country:US
Mailing Address - Phone:817-369-8614
Mailing Address - Fax:817-535-3855
Practice Address - Street 1:4700 S RIVERSIDE DR
Practice Address - Street 2:
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76119-5523
Practice Address - Country:US
Practice Address - Phone:817-369-8614
Practice Address - Fax:817-535-3855
Is Sole Proprietor?:No
Enumeration Date:2023-06-01
Last Update Date:2023-06-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor