Provider Demographics
NPI:1346609203
Name:BERGDALE & HALL, LLC
Entity Type:Organization
Organization Name:BERGDALE & HALL, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:SARA
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:HALL
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:702-308-4807
Mailing Address - Street 1:6879 W CHARLESTON BLVD
Mailing Address - Street 2:SUITE A
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89117-1672
Mailing Address - Country:US
Mailing Address - Phone:702-376-0024
Mailing Address - Fax:702-479-7173
Practice Address - Street 1:6879 W CHARLESTON BLVD
Practice Address - Street 2:SUITE A
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89117-1672
Practice Address - Country:US
Practice Address - Phone:702-376-0024
Practice Address - Fax:702-479-7173
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-02-19
Last Update Date:2016-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NVNV201010142362084P0804X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0804XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyChild & Adolescent PsychiatryGroup - Multi-Specialty