Provider Demographics
NPI:1205052420
Name:BERGESON, BRADLEY J (MED, LMHP, LADC)
Entity type:Individual
Prefix:MR
First Name:BRADLEY
Middle Name:J
Last Name:BERGESON
Suffix:
Gender:M
Credentials:MED, LMHP, LADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2841 S SAINT AUBIN ST
Mailing Address - Street 2:
Mailing Address - City:SIOUX CITY
Mailing Address - State:IA
Mailing Address - Zip Code:51106-3420
Mailing Address - Country:US
Mailing Address - Phone:712-223-4308
Mailing Address - Fax:
Practice Address - Street 1:2101 COURT ST
Practice Address - Street 2:
Practice Address - City:SIOUX CITY
Practice Address - State:IA
Practice Address - Zip Code:51104-3243
Practice Address - Country:US
Practice Address - Phone:712-293-4700
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-04-17
Last Update Date:2016-11-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE608101YA0400X
NE3721101YM0800X
101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)