Provider Demographics
NPI:1720594906
Name:BERG, LENA
Entity Type:Individual
Prefix:
First Name:LENA
Middle Name:
Last Name:BERG
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15920 NE 16TH PL
Mailing Address - Street 2:
Mailing Address - City:BELLEVUE
Mailing Address - State:WA
Mailing Address - Zip Code:98008-2716
Mailing Address - Country:US
Mailing Address - Phone:206-619-4300
Mailing Address - Fax:
Practice Address - Street 1:15920 NE 16TH PL
Practice Address - Street 2:
Practice Address - City:BELLEVUE
Practice Address - State:WA
Practice Address - Zip Code:98008-2716
Practice Address - Country:US
Practice Address - Phone:206-619-4300
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-12-24
Last Update Date:2017-12-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health