Provider Demographics
NPI:1629316658
Name:BERGHUIS, DEBORAH (PHD, LPC, LPCC)
Entity Type:Individual
Prefix:DR
First Name:DEBORAH
Middle Name:
Last Name:BERGHUIS
Suffix:
Gender:F
Credentials:PHD, LPC, LPCC
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 7146
Mailing Address - Street 2:
Mailing Address - City:BOULDER
Mailing Address - State:CO
Mailing Address - Zip Code:80306-7146
Mailing Address - Country:US
Mailing Address - Phone:937-344-3939
Mailing Address - Fax:
Practice Address - Street 1:3208 LAKE PARK WAY APT 302
Practice Address - Street 2:
Practice Address - City:LONGMONT
Practice Address - State:CO
Practice Address - Zip Code:80503-7804
Practice Address - Country:US
Practice Address - Phone:937-344-3939
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-01-25
Last Update Date:2023-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHE.1800686101YP2500X
COLPC.0016707101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
OHE.1800686OtherCSWMFT BOARD
COLPC.0016707OtherCOLORADO DEPARTMENT OF REGULATORY AGENCIES DIVISION OF PROFESSIONS AND OCCUPATIO
COLPC.0016707OtherSTATE BOARD OF LICENSED PROFESSIONAL COUNSELOR EXAMINERS