Provider Demographics
NPI:1437323524
Name:BERGAN, ANGELA MARY (LMFT)
Entity Type:Individual
Prefix:MS
First Name:ANGELA
Middle Name:MARY
Last Name:BERGAN
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 308
Mailing Address - Street 2:
Mailing Address - City:POSTVILLE
Mailing Address - State:IA
Mailing Address - Zip Code:52162-0308
Mailing Address - Country:US
Mailing Address - Phone:563-864-7122
Mailing Address - Fax:563-864-7123
Practice Address - Street 1:307 WILSON ST
Practice Address - Street 2:
Practice Address - City:POSTVILLE
Practice Address - State:IA
Practice Address - Zip Code:52162
Practice Address - Country:US
Practice Address - Phone:563-864-7122
Practice Address - Fax:563-864-7123
Is Sole Proprietor?:No
Enumeration Date:2008-04-18
Last Update Date:2008-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA00073106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA28723OtherWELLMARK, INC