Provider Demographics
NPI:1639330285
Name:BERTLING-SAFFORD, MARY ELLEN RAE (MA, LPC)
Entity Type:Individual
Prefix:
First Name:MARY ELLEN
Middle Name:RAE
Last Name:BERTLING-SAFFORD
Suffix:
Gender:F
Credentials:MA, LPC
Other - Prefix:
Other - First Name:MARY ELLEN
Other - Middle Name:RAE
Other - Last Name:BERTLING
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1034 LOOKOUT RDG
Mailing Address - Street 2:
Mailing Address - City:MESQUITE
Mailing Address - State:NV
Mailing Address - Zip Code:89034-1195
Mailing Address - Country:US
Mailing Address - Phone:616-920-0823
Mailing Address - Fax:866-721-6199
Practice Address - Street 1:1034 LOOKOUT RDG
Practice Address - Street 2:
Practice Address - City:MESQUITE
Practice Address - State:NV
Practice Address - Zip Code:89034-1195
Practice Address - Country:US
Practice Address - Phone:616-920-0823
Practice Address - Fax:866-721-6199
Is Sole Proprietor?:Yes
Enumeration Date:2008-06-17
Last Update Date:2023-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NVCP1132101Y00000X, 101YP2500X
MI6401007799101Y00000X, 101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101Y00000XBehavioral Health & Social Service ProvidersCounselor