Michael I Bergman
Individual provider Active NPI Mental Health Counselor · Olympia, WA
NPI 1972050466 · NPPES record last updated Feb 26, 2024
Key facts
- NPI
- 1972050466
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Mental Health Counselor 101YM0800X
- License
- 60446978 (WA)
- Practice address
- 2101 4TH Ave E Ste 200
Olympia, WA 98506-6512 - Phone
- (503) 887-4137
- Fax
- (360) 956-0379
- NPI assigned
- Sep 1, 2016
- Sex
- Male
- Sole proprietor
- Yes
Organizations & group practices 1
Medicare Care Compare profile
- Specialty
- Mental Health Counselor
- Education
- Other, 2013
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
Practice addresses (Care Compare)
2101 4TH Ave E
Suite 200
Olympia, WA 98506-6512
Phone (503) 887-4137
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in WA
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: No · Power mobility devices: No · Hospice: No
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20240318003210 | WA | Practitioner - Mental Health Counselor | 0446697114 | Practice locations: Olympia, WA |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 60446978 | WA | MD | Mental Health Counselor |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Halcyon Counseling | Mental Health | Past | Accepting new patients |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Mental Health Counselor | 101YM0800X | 60446978 | WA | Yes |
Addresses
Primary practice location
2101 4TH Ave E Ste 200
Olympia, WA 98506-6512
Mailing address
2101 4TH Ave E Ste 200
Olympia, WA 98506-6512
Phone (503) 887-4137
Other providers in Olympia, WA
- Jackie Marie Berge
- Mathew Bergendahl
- Matthew S Berger
- Philip William Berger
- Jude Bergkamp
- Bobbie Berkey
- Joan A Berkey
- Dara S Bernal
- Judy L Bernard
- Katherine Berndt
All providers in Olympia, WA · Mental Health 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 Feb 26, 2024. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.