Frederick Douglas Bergh I, LPC, LAT
Individual provider Active NPI Professional Counselor · Casper, WY
NPI 1568940211 · NPPES record last updated Aug 7, 2024
Key facts
- NPI
- 1568940211
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Professional Counselor 101YP2500X
- License
- LPC-2038 (WY)
- Practice address
- 701 Antler Dr Ste 213
Casper, WY 82601-1726 - Phone
- (720) 484-1961
- NPI assigned
- Aug 3, 2018
- Sex
- Male
- Sole proprietor
- No
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| LAT-404 | WY | MD | Addiction (Substance Use Disorder) Counselor |
| LPC-2038 | WY | MD | Professional Counselor |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Addiction (Substance Use Disorder) Counselor | 101YA0400X | LAT-404 | WY | |
| Professional Counselor | 101YP2500X | LPC-2038 | WY | Yes |
| Mental Health Counselor | 101YM0800X | LPC-2038 | WY |
Addresses
Primary practice location
701 Antler Dr Ste 213
Casper, WY 82601-1726
Mailing address
701 Antler Dr Ste 213
Casper, WY 82601-1726
Phone (720) 484-1961
Other providers in Casper, WY
- Cathy L Berens
- Jennifer L Berg
- Kelsey J Berg
- Melissa Jo Berg
- Alex J Bergeron
- Peter E Bergquist
- Wilson Fulla Bernales
- Brianna Berquam
- Amy Berry
- Matthew David Bertagnole
All providers in Casper, WY · Professional Counselor in Wyoming
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Aug 7, 2024. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.