Provider Demographics
NPI:1558736785
Name:BERGLUND, BECKY SUE (LCPC)
Entity Type:Individual
Prefix:
First Name:BECKY
Middle Name:SUE
Last Name:BERGLUND
Suffix:
Gender:F
Credentials:LCPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:141 DISCOVERY DR
Mailing Address - Street 2:SUITE 116
Mailing Address - City:BOZEMAN
Mailing Address - State:MT
Mailing Address - Zip Code:59718-6995
Mailing Address - Country:US
Mailing Address - Phone:406-599-3528
Mailing Address - Fax:
Practice Address - Street 1:141 DISCOVERY DR
Practice Address - Street 2:SUITE 116
Practice Address - City:BOZEMAN
Practice Address - State:MT
Practice Address - Zip Code:59718-6995
Practice Address - Country:US
Practice Address - Phone:406-599-3528
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-12-14
Last Update Date:2015-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MTBBH-LCPC-LIC-13848101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional