Provider Demographics
NPI:1538296710
Name:BERGEN, CAROLE (MARRIAGE&FAMILY THER)
Entity Type:Individual
Prefix:DR
First Name:CAROLE
Middle Name:
Last Name:BERGEN
Suffix:
Gender:F
Credentials:MARRIAGE&FAMILY THER
Other - Prefix:
Other - First Name:CAROLE
Other - Middle Name:
Other - Last Name:BERGEN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MARRIAGE & FAMILY TH
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
Is Sole Proprietor?:No
Enumeration Date:2007-02-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALF00001753106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist