Provider Demographics
NPI:1578101473
Name:BRADI BERGESEN COUNSELING PLLC
Entity Type:Organization
Organization Name:BRADI BERGESEN COUNSELING PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:BRADI
Authorized Official - Middle Name:
Authorized Official - Last Name:BERGESEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:360-209-7680
Mailing Address - Street 1:1653 TOWNE RD
Mailing Address - Street 2:
Mailing Address - City:SEQUIM
Mailing Address - State:WA
Mailing Address - Zip Code:98382-8867
Mailing Address - Country:US
Mailing Address - Phone:360-209-7680
Mailing Address - Fax:360-326-1143
Practice Address - Street 1:1653 TOWNE RD
Practice Address - Street 2:
Practice Address - City:SEQUIM
Practice Address - State:WA
Practice Address - Zip Code:98382-8867
Practice Address - Country:US
Practice Address - Phone:360-209-7680
Practice Address - Fax:360-326-1143
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-12-11
Last Update Date:2022-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty