Amy Bergstrom, LPC
Individual provider Active NPI Professional Counselor · Wayne, PA
NPI 1831602218 · NPPES record last updated Oct 31, 2023
Key facts
- NPI
- 1831602218
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Professional Counselor 101YP2500X
- License
- PC012237 (PA)
- Practice address
- 300 N Wayne Ave Apt 5
Wayne, PA 19087-3239 - Phone
- (815) 575-2014
- NPI assigned
- Nov 8, 2017
- Reactivated
- Nov 14, 2017
- Sex
- Female
- Sole proprietor
- Yes
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 |
|---|---|---|---|
| LC9490 | MD | MD | Professional Counselor |
| PC012237 | PA | MD | Professional Counselor |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Aspire Wellness Center, Inc. | Past | Accepting new patients | |
| Optum Behavioral Care of Connecticut, P.C. | Past |
Accepting new patients |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Mental Health Counselor | 101YM0800X | |||
| Professional Counselor | 101YP2500X | LC9490 | MD | |
| Professional Counselor | 101YP2500X | PC012237 | PA | Yes |
Addresses
Primary practice location
300 N Wayne Ave Apt 5
Wayne, PA 19087-3239
Mailing address
300 N Wayne Ave Apt 5
Wayne, PA 19087-3239
Phone (815) 575-2014
Other providers in Wayne, PA
- Mariam Bedoidze
- Joanna D Bell
- Selena Belohoubek
- Zachary Paul Benevides
- Sharon Noel Bentley
- David A Bernstein
- Philip E Bernstein
- Mark Bersheim
- Mariann Bevenour
- BFC Networks, LTD
All providers in Wayne, PA · Professional Counselor in Pennsylvania
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Oct 31, 2023. 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.