Provider Demographics
NPI:1356616445
Name:BERG, ALYXX S (MS, LMHC, CDP)
Entity type:Individual
Prefix:
First Name:ALYXX
Middle Name:S
Last Name:BERG
Suffix:
Gender:F
Credentials:MS, LMHC, CDP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6510 4TH AVE NE APT 4
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98115-6441
Mailing Address - Country:US
Mailing Address - Phone:067-139-2642
Mailing Address - Fax:
Practice Address - Street 1:6510 4TH AVE NE APT 4
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98115-6441
Practice Address - Country:US
Practice Address - Phone:067-139-2642
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-03-21
Last Update Date:2024-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WACP00006358101YA0400X
ORC6758101YM0800X
IDLCPC8747101YM0800X
WALH60764063101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)