Douglas a. Bergstrom, PH.D., PLLC

Primary specialty

Community/Behavioral Health AgencyTaxonomy code 251S00000X

License

1142 Issued in AZ

Legal business name

DOUGLAS A. BERGSTROM, PH.D., PLLC

Practice address

143 E Merritt St
Prescott, AZ 86301-2028

Phone

(928) 445-3835

Fax

(928) 445-7071

NPI assigned

Nov 13, 2007

Last updated

Nov 13, 2007By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Douglas Alan Bergstrom, PH.D.NPI 1063536688

Title

Psychologist

Phone

(928) 445-3835

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in AZ

Enrollment records 1

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Douglas Alan Bergstrom, PH.D.

  • Clinical Psychologist
  • Prescott, AZ
  • NPI 1063536688
  Medicare reassignment NPD Authorized official
• Esther N Greenwald, P.T.

  • Orthopedic Physical Therapist
  • Prescott, AZ
  • NPI 1740239441
  NPD (past)

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

{
    "created_epoch": "1194912000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1194912000000",
    "number": "1154501682",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "143 E MERRITT ST",
            "city": "PRESCOTT",
            "state": "AZ",
            "postal_code": "863012028",
            "telephone_number": "928-445-3835",
            "fax_number": "928-445-7071"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "143 E MERRITT ST",
            "city": "PRESCOTT",
            "state": "AZ",
            "postal_code": "863012028",
            "telephone_number": "928-445-3835",
            "fax_number": "928-445-7071"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "DOUGLAS A. BERGSTROM, PH.D., PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-11-13",
        "last_updated": "2007-11-13",
        "status": "A",
        "authorized_official_last_name": "BERGSTROM",
        "authorized_official_first_name": "DOUGLAS",
        "authorized_official_middle_name": "ALAN",
        "authorized_official_title_or_position": "PSYCHOLOGIST",
        "authorized_official_telephone_number": "928-445-3835",
        "authorized_official_credential": "PH.D."
    },
    "taxonomies": [
        {
            "code": "251S00000X",
            "taxonomy_group": "",
            "desc": "Community/Behavioral Health",
            "state": "AZ",
            "license": "1142",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Silvana Martins Lourenco Domaz
• Joseph Donaldson
• Robert Louis Donaldson, D.D.S.
• Mary Colleen Donnelly, M.D.
• Heather Anne Donovan
• Douglas L Shepard MD PA
• Brandon Gregory Dowler
• Crystal Downer, DO
• Samuel William Downing V, M.D.
• Kevin S Doyle, MD

• Community/Behavioral Health Agency in Prescott, AZ
• Providers in Prescott, AZ by specialty
• Community/Behavioral Health Agency in Arizona

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 13, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.