Susan Diane Bergen, MA, LMFT

Primary specialty

Marriage & Family TherapistTaxonomy code 106H00000X

License

LMFT-2962 Issued in ID

Practice address

647 Filer Ave
Twin Falls, ID 83301-4008

Phone

(208) 737-9999

Fax

(208) 736-4400

NPI assigned

Sep 26, 2006

Last updated

Jul 8, 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 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Credentials

Master of Arts

State licenses

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

{
    "created_epoch": "1159228800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1497856637",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "225 LONG ISLAND AVE",
            "city": "TWIN FALLS",
            "state": "ID",
            "postal_code": "833013096",
            "telephone_number": "208-735-1561",
            "fax_number": "208-736-4400"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "647 FILER AVE",
            "city": "TWIN FALLS",
            "state": "ID",
            "postal_code": "833014008",
            "telephone_number": "208-737-9999",
            "fax_number": "208-736-4400"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BERGEN",
        "first_name": "SUSAN",
        "middle_name": "DIANE",
        "credential": "MA, LMFT",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-09-26",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "106H00000X",
            "taxonomy_group": "",
            "desc": "Marriage & Family Therapist",
            "state": "ID",
            "license": "LMFT-2962",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "REGENCE BLUE SHIELD",
            "identifier": "000010157599",
            "state": "ID"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Natasha Bennett, PHARM D
• Sabrina L Bennett
• Bryce William Bennion, RPH
• Garrett A Bentley, DO
• Delaney Bergen, ATC, LAT
• Esmeralda Berruete
• David Franklin Berry, MSPT
• Betts Psychiatric PC
• Isabella Betts, PHARMD
• William E Betts, PMHNP

• Marriage & Family Therapist in Twin Falls, ID
• Providers in Twin Falls, ID by specialty
• Marriage & Family Therapist in Idaho

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.