Individual provider Active NPI

Virginia Bergstrom, LMFT

  • Mental Health Counselor
  • Fresno, CA
National Provider Identifier
1609929900
Registry record updated Jul 8, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
Mental Health CounselorTaxonomy code 101YM0800X
License
LMFT39596 Issued in CA
Practice address
5588 N Palm Ave
Fresno, CA 93704-1913
Phone
(559) 440-0980
Fax
(559) 440-0982
NPI assigned
Jan 19, 2007
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Jul 8, 2007

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Mental Health Counselor 101YM0800X LMFT39596 CA Primary

Addresses

Primary practice location

5588 N Palm Ave
Fresno, CA 93704-1913

Mailing address

5588 N Palm Ave
Fresno, CA 93704-1913
Phone (559) 440-0980

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CA
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: No
  • Power mobility devices: No
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20240206001440 CA Practitioner - Marriage and Family Therapist 4789027889 Practice locations: Fresno, CA

Care Compare profile

Medicare Care Compare
Specialty
Marriage and Family Therapist
Education
Other, 1999
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services

Practice addresses (Care Compare)

Fresno, CA 93722
Phone (559) 259-1048

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
LMFT39596CAMDMental Health Counselor
39596CAMDOncology Pharmacist

NPI Registry JSON

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

{
    "created_epoch": "1169164800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1609929900",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5588 N PALM AVE",
            "city": "FRESNO",
            "state": "CA",
            "postal_code": "937041913",
            "telephone_number": "559-440-0980",
            "fax_number": "559-440-0982"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5588 N PALM AVE",
            "city": "FRESNO",
            "state": "CA",
            "postal_code": "937041913",
            "telephone_number": "559-440-0980",
            "fax_number": "559-440-0982"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BERGSTROM",
        "first_name": "VIRGINIA",
        "name_prefix": "Mrs.",
        "credential": "LMFT",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2007-01-19",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YM0800X",
            "taxonomy_group": "",
            "desc": "Counselor, Mental Health",
            "state": "CA",
            "license": "LMFT39596",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Fresno, CA

Sources for this page

Verify at the official NPI Registry.