Provider Demographics
NPI:1508137738
Name:KAREN BERGBOWER & ASSOCIATES
Entity Type:Organization
Organization Name:KAREN BERGBOWER & ASSOCIATES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MS
Authorized Official - First Name:KAREN
Authorized Official - Middle Name:JOAN
Authorized Official - Last Name:BERGBOWER
Authorized Official - Suffix:
Authorized Official - Credentials:LMSW
Authorized Official - Phone:810-225-9550
Mailing Address - Street 1:10299 GRAND RIVER
Mailing Address - Street 2:SUITE P
Mailing Address - City:BRIGHTON
Mailing Address - State:MI
Mailing Address - Zip Code:48116
Mailing Address - Country:US
Mailing Address - Phone:810-225-9550
Mailing Address - Fax:810-225-9579
Practice Address - Street 1:10299 GRAND RIVER RD
Practice Address - Street 2:SUITE P
Practice Address - City:BRIGHTON
Practice Address - State:MI
Practice Address - Zip Code:48116-6541
Practice Address - Country:US
Practice Address - Phone:810-225-9550
Practice Address - Fax:810-225-9579
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-01-19
Last Update Date:2012-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI470092251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health