Provider Demographics
NPI:1376777474
Name:BERGT, AMANDA RACHEL (MS, LPC)
Entity Type:Individual
Prefix:MRS
First Name:AMANDA
Middle Name:RACHEL
Last Name:BERGT
Suffix:
Gender:F
Credentials:MS, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5425 PLAZA DR
Mailing Address - Street 2:
Mailing Address - City:TEXARKANA
Mailing Address - State:TX
Mailing Address - Zip Code:75503-1662
Mailing Address - Country:US
Mailing Address - Phone:903-838-3711
Mailing Address - Fax:
Practice Address - Street 1:5425 PLAZA DR
Practice Address - Street 2:
Practice Address - City:TEXARKANA
Practice Address - State:TX
Practice Address - Zip Code:75503-1662
Practice Address - Country:US
Practice Address - Phone:903-838-3711
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-05-05
Last Update Date:2009-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX63389101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health