Provider Demographics
NPI:1245764000
Name:BERGES, GEORGIA (MFT)
Entity Type:Individual
Prefix:
First Name:GEORGIA
Middle Name:
Last Name:BERGES
Suffix:
Gender:F
Credentials:MFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10414 WOODBRIDGE ST
Mailing Address - Street 2:
Mailing Address - City:TOLUCA LAKE
Mailing Address - State:CA
Mailing Address - Zip Code:91602-2823
Mailing Address - Country:US
Mailing Address - Phone:818-769-5156
Mailing Address - Fax:818-766-8842
Practice Address - Street 1:10414 WOODBRIDGE ST
Practice Address - Street 2:
Practice Address - City:TOLUCA LAKE
Practice Address - State:CA
Practice Address - Zip Code:91602-2823
Practice Address - Country:US
Practice Address - Phone:818-769-5156
Practice Address - Fax:818-766-8842
Is Sole Proprietor?:Yes
Enumeration Date:2017-04-18
Last Update Date:2017-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMA021194106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist