Provider Demographics
NPI:1619269982
Name:OTTO-BERGLUND, RENEE (MS, LIPC)
Entity Type:Individual
Prefix:MS
First Name:RENEE
Middle Name:
Last Name:OTTO-BERGLUND
Suffix:
Gender:F
Credentials:MS, LIPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 604
Mailing Address - Street 2:
Mailing Address - City:NORFOLK
Mailing Address - State:NE
Mailing Address - Zip Code:68702-0604
Mailing Address - Country:US
Mailing Address - Phone:402-841-8351
Mailing Address - Fax:
Practice Address - Street 1:1010 RIVERSIDE BLVD STE B
Practice Address - Street 2:
Practice Address - City:NORFOLK
Practice Address - State:NE
Practice Address - Zip Code:68701-3027
Practice Address - Country:US
Practice Address - Phone:402-841-8351
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-05-05
Last Update Date:2023-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE573101YP2500X, 101YP2500X
NE268101YM0800X, 101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional