Provider Demographics
NPI:1558423400
Name:BERGKOETTER, MILIA BETH (MS MFCC LCPC)
Entity Type:Individual
Prefix:MS
First Name:MILIA
Middle Name:BETH
Last Name:BERGKOETTER
Suffix:
Gender:F
Credentials:MS MFCC LCPC
Other - Prefix:MS
Other - First Name:MILIA
Other - Middle Name:BETH
Other - Last Name:HANCE HOSSEINI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MS MFCC LCPC
Mailing Address - Street 1:8802 S 700 W
Mailing Address - Street 2:
Mailing Address - City:WILLIAMSPORT
Mailing Address - State:IN
Mailing Address - Zip Code:47993
Mailing Address - Country:US
Mailing Address - Phone:765-793-7318
Mailing Address - Fax:
Practice Address - Street 1:1022 N VERMILION
Practice Address - Street 2:
Practice Address - City:DANVILLE
Practice Address - State:IL
Practice Address - Zip Code:61832
Practice Address - Country:US
Practice Address - Phone:217-446-4747
Practice Address - Fax:217-446-1734
Is Sole Proprietor?:No
Enumeration Date:2006-12-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor
Provider Identifiers
StateIdentifier IDID TypeIssuer
09227965OtherBC BS