Provider Demographics
NPI:1164938320
Name:BERVEN, MARK (LADC, LPC)
Entity Type:Individual
Prefix:
First Name:MARK
Middle Name:
Last Name:BERVEN
Suffix:
Gender:M
Credentials:LADC, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:44 ARTHUR AVE SE
Mailing Address - Street 2:
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55414-3448
Mailing Address - Country:US
Mailing Address - Phone:612-964-1747
Mailing Address - Fax:
Practice Address - Street 1:555 7TH ST W STE 203
Practice Address - Street 2:
Practice Address - City:SAINT PAUL
Practice Address - State:MN
Practice Address - Zip Code:55102-3068
Practice Address - Country:US
Practice Address - Phone:612-964-1747
Practice Address - Fax:612-964-1747
Is Sole Proprietor?:Yes
Enumeration Date:2017-12-22
Last Update Date:2017-12-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN304104101YA0400X
MN01987101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)