Amy Bergholtz, B.S.

Primary specialty

Mental Health CounselorTaxonomy code 101YM0800X

Practice address

12450 Van Nuys Blvd
Suite 200
Pacoima, CA 91331-1391

Phone

(818) 896-1161

Fax

(818) 896-5069

NPI assigned

Mar 8, 2007

Last updated

Jul 9, 2007By the provider in NPPES

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other identifiers 2

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Eligible to order & refer

• Part B services: No
• Medical equipment: Yes
• Home health: No
• Power mobility devices: No
• Hospice: No

Green means eligible to order or refer.

Medicare enrollment (NPD)

Enrolled

Credentials

Bachelor of Science

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Uhs of Hartgrove, Inc

  dba UHS of Hartgrove-Chatham Counseling Center

  • Child & Adolescent Psychiatry Physician
  • Chicago, IL
  • NPI 1538560339
  NPD
• Uhs of Hartgrove, Inc.

  • Psychiatric Hospital
  • Chicago, IL
  • NPI 1396012951
  NPD
• Uhs of Hartgrove, Inc

  dba Oak Park Counseling Center

  • Child & Adolescent Psychiatry Physician
  • Oak Park, IL
  • NPI 1396981627
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1173312000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183939200000",
    "number": "1124159454",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "257 1/2 ISABEL ST.",
            "city": "LOS ANGELES",
            "state": "CA",
            "postal_code": "90065"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "12450 VAN NUYS BLVD",
            "address_2": "SUITE 200",
            "city": "PACOIMA",
            "state": "CA",
            "postal_code": "913311391",
            "telephone_number": "818-896-1161",
            "fax_number": "818-896-5069"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BERGHOLTZ",
        "first_name": "AMY",
        "name_prefix": "Ms.",
        "credential": "B.S.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2007-03-08",
        "last_updated": "2007-07-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YM0800X",
            "taxonomy_group": "",
            "desc": "Counselor, Mental Health",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "7420",
            "state": "CA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "7068",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Janette Baucham, LMFT
• Imelda Bealer
• Noemi M Beck, PSY.D.
• Esperanza Saucedo Bedolla, BA
• Monique Benjamin
• Riquerme Berroa Jr.
• Saba Billoo
• Angelica Bivian
• Blanc Medical Supplies
• Blanc Medical Supplies Inc

• Mental Health Counselor in Pacoima, CA
• Providers in Pacoima, CA by specialty
• Mental Health Counselor in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 9, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.