Kevin R Bergeron, SUDPT
Individual provider Active NPI Addiction (Substance Use Disorder) Counselor · Milton, WA
NPI 1700527280 · NPPES record last updated Aug 13, 2024
Key facts
- NPI
- 1700527280
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Addiction (Substance Use Disorder) Counselor 101YA0400X
- License
- CO61275243 (WA)
- Practice address
- 1703 Douglas CT
Milton, WA 98354-9727 - Phone
- (360) 888-7087
- NPI assigned
- Apr 6, 2022
- Sex
- Male
- Sole proprietor
- No
Organizations & group practices 2
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 |
|---|---|---|---|
| CO61275243 | WA | MD | Addiction (Substance Use Disorder) Counselor |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Resurgence Northwest LLC | Current | Accepting new patients | |
| Remnant Army Northwest | Current | Accepting new patients |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Addiction (Substance Use Disorder) Counselor | 101YA0400X | CO61275243 | WA | Yes |
Addresses
Primary practice location
1703 Douglas CT
Milton, WA 98354-9727
Mailing address
500 SE Washington Ave
Chehalis, WA 98532-3058
Phone (360) 748-4776
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 2077844 | Medicaid | WA |
Other providers in Milton, WA
- Cyan Agrawal
- Ildefonso Arguelles
- Assisted Living Alternatives
- Betsy Darlene Bailey
- Jose Michael Bayas
- Barbara Lyn Bishop
- Jennie Bonfiglio
- Shawn Boynton
- Danielle Burkett
- C & J Homes, LLC
All providers in Milton, WA · Addiction (Substance Use Disorder) Counselor in Washington
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Aug 13, 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.