Provider Demographics
NPI:1275110769
Name:PENELOPE BERGERON COUNSELING
Entity Type:Organization
Organization Name:PENELOPE BERGERON COUNSELING
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:PENELOPE
Authorized Official - Middle Name:LYNN
Authorized Official - Last Name:BERGERON
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:801-318-7037
Mailing Address - Street 1:5702 W 10770 N
Mailing Address - Street 2:
Mailing Address - City:HIGHLAND
Mailing Address - State:UT
Mailing Address - Zip Code:84003-9087
Mailing Address - Country:US
Mailing Address - Phone:801-318-7037
Mailing Address - Fax:801-877-9216
Practice Address - Street 1:212 S MAIN ST STE 201
Practice Address - Street 2:
Practice Address - City:SPANISH FORK
Practice Address - State:UT
Practice Address - Zip Code:84660-5738
Practice Address - Country:US
Practice Address - Phone:385-202-4089
Practice Address - Fax:801-877-9216
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-03-29
Last Update Date:2021-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty