Provider Demographics
NPI:1760923189
Name:BERGEN, MARTHA FRANCES (PHD, LICENSED PSYCHO)
Entity Type:Individual
Prefix:DR
First Name:MARTHA
Middle Name:FRANCES
Last Name:BERGEN
Suffix:
Gender:F
Credentials:PHD, LICENSED PSYCHO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3605 YUCCA DRIVE
Mailing Address - Street 2:SUITE 202
Mailing Address - City:FLOWER MOUND
Mailing Address - State:TX
Mailing Address - Zip Code:75028
Mailing Address - Country:US
Mailing Address - Phone:972-656-8208
Mailing Address - Fax:
Practice Address - Street 1:3605 YUCCA DRIVE
Practice Address - Street 2:SUITE 202
Practice Address - City:FLOWER MOUND
Practice Address - State:TX
Practice Address - Zip Code:75028
Practice Address - Country:US
Practice Address - Phone:972-656-8208
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-03-17
Last Update Date:2021-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX36363103TC1900X
TXTX36363103TC1900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounseling