Provider Demographics
NPI:1477680668
Name:CAROLE BERGEN & ASSOCIATES, INC.
Entity Type:Organization
Organization Name:CAROLE BERGEN & ASSOCIATES, INC.
Other - Org Name:CAROLE BERGEN PH.D.
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:CAROLE
Authorized Official - Middle Name:
Authorized Official - Last Name:BERGEN
Authorized Official - Suffix:
Authorized Official - Credentials:MARRIAGE & FAMILY TH
Authorized Official - Phone:253-853-5800
Mailing Address - Street 1:9814 HARBORVIEW PL
Mailing Address - Street 2:
Mailing Address - City:GIG HARBOR
Mailing Address - State:WA
Mailing Address - Zip Code:98332-1018
Mailing Address - Country:US
Mailing Address - Phone:253-853-5800
Mailing Address - Fax:253-858-5430
Practice Address - Street 1:9814 HARBORVIEW PL
Practice Address - Street 2:
Practice Address - City:GIG HARBOR
Practice Address - State:WA
Practice Address - Zip Code:98332-1018
Practice Address - Country:US
Practice Address - Phone:253-853-5800
Practice Address - Fax:253-858-5430
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-27
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALF00001753101Y00000X, 106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Not Answered101Y00000XBehavioral Health & Social Service ProvidersCounselorGroup - Single Specialty
Not Answered106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Single Specialty