Provider Demographics
NPI:1235613936
Name:BERGERON, ALEXA JOY (LPC)
Entity Type:Individual
Prefix:
First Name:ALEXA
Middle Name:JOY
Last Name:BERGERON
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2439 BROADWAY ST STE 203
Mailing Address - Street 2:
Mailing Address - City:BOULDER
Mailing Address - State:CO
Mailing Address - Zip Code:80304-4108
Mailing Address - Country:US
Mailing Address - Phone:954-732-0632
Mailing Address - Fax:
Practice Address - Street 1:2439 BROADWAY ST STE 203
Practice Address - Street 2:
Practice Address - City:BOULDER
Practice Address - State:CO
Practice Address - Zip Code:80304-4108
Practice Address - Country:US
Practice Address - Phone:954-732-0632
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-09-18
Last Update Date:2018-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COLPC.0014881101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health