Provider Demographics
NPI:1851807093
Name:BERGO, KRISTEN MICHELLE (CATC-1)
Entity Type:Individual
Prefix:MRS
First Name:KRISTEN
Middle Name:MICHELLE
Last Name:BERGO
Suffix:
Gender:F
Credentials:CATC-1
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:20134 LEADWELL ST UNIT 253
Mailing Address - Street 2:
Mailing Address - City:WINNETKA
Mailing Address - State:CA
Mailing Address - Zip Code:91306-4928
Mailing Address - Country:US
Mailing Address - Phone:818-802-0195
Mailing Address - Fax:
Practice Address - Street 1:660 E LOS ANGELES AVE STE B2
Practice Address - Street 2:
Practice Address - City:SIMI VALLEY
Practice Address - State:CA
Practice Address - Zip Code:93065-1884
Practice Address - Country:US
Practice Address - Phone:805-522-1844
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-12-26
Last Update Date:2017-12-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)