Provider Demographics
NPI:1710679444
Name:BERGLAND, KEMMA (LPCC)
Entity Type:Individual
Prefix:
First Name:KEMMA
Middle Name:
Last Name:BERGLAND
Suffix:
Gender:F
Credentials:LPCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:25122 STATE HIGHWAY 28
Mailing Address - Street 2:
Mailing Address - City:GLENWOOD
Mailing Address - State:MN
Mailing Address - Zip Code:56334-3390
Mailing Address - Country:US
Mailing Address - Phone:320-239-4800
Mailing Address - Fax:
Practice Address - Street 1:25122 STATE HIGHWAY 28
Practice Address - Street 2:
Practice Address - City:GLENWOOD
Practice Address - State:MN
Practice Address - Zip Code:56334-3390
Practice Address - Country:US
Practice Address - Phone:320-239-4800
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-05-22
Last Update Date:2023-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN3480101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health