Provider Demographics
NPI:1083921258
Name:BERGERON, LINDA ALLEN (LPC, LMFT)
Entity Type:Individual
Prefix:MRS
First Name:LINDA
Middle Name:ALLEN
Last Name:BERGERON
Suffix:
Gender:F
Credentials:LPC, LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 192
Mailing Address - Street 2:
Mailing Address - City:MILTON
Mailing Address - State:LA
Mailing Address - Zip Code:70558-0192
Mailing Address - Country:US
Mailing Address - Phone:337-254-1803
Mailing Address - Fax:
Practice Address - Street 1:809 ESPASIE RD LOT D
Practice Address - Street 2:
Practice Address - City:YOUNGSVILLE
Practice Address - State:LA
Practice Address - Zip Code:70592-5798
Practice Address - Country:US
Practice Address - Phone:337-254-1803
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-09-08
Last Update Date:2010-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA2270101YP2500X
LA374106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist