NPIMap

Organization Active NPI

Bergdale & Hall, LLC

Doing business as Serenity Counseling and Support Services

  • Clinical Social Worker
  • Las Vegas, NV
National Provider Identifier
1972814630
Registry record updated Sep 19, 2016
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical Social WorkerTaxonomy code 1041C0700X
License
5554-C Issued in NV
Legal business name
BERGDALE & HALL, LLC
Doing business as
Serenity Counseling and Support Services
Practice address
6879 W Charleston Blvd
Suite a
Las Vegas, NV 89117-1672
Phone
(702) 308-4807
Fax
(702) 479-7173
NPI assigned
Jun 28, 2010
Last updated
Sep 19, 2016By the provider in NPPES
Organization subpart
Yes
Parent organization
BERGDALE & HALL, LLCAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Sep 19, 2016

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

Authorized official

Name
Sommer Thyme Bergdale, MA.NPI 1013243591
Title
Co-Owner
Phone
(702) 376-0024

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Clinical Social WorkerGroup: 193200000X MULTI-SPECIALTY GROUP 1041C0700X 5554-C NV Primary

Addresses

Primary practice location

6879 W Charleston Blvd
Suite a
Las Vegas, NV 89117-1672

Mailing address

6879 W Charleston Blvd
Suite a
Las Vegas, NV 89117-1672
Phone (702) 308-4807

Other names 1

  • Serenity Counseling and Support Services Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NV

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20161024001598 NV Part B Supplier - Clinic/Group Practice 5698076602 Receives reassigned benefits from 10 practitioners
1 other NPI on this enrollment
Practice locations: Las Vegas, NV

Other NPIs on the same Medicare enrollment 1

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

National Provider Directory

National Provider Directory
Tax ID family
Bergdale Hall LLC3 organizations share this tax ID, including this one
Part of
Bergdale Hall LLC

Other organizations with this tax ID 2

Organizations that report the same tax identification number in the National Provider Directory.

Member of 1

Organizations this organization is a member of, according to the National Provider Directory.

Locations

6885 W Charleston Blvd
Las Vegas, NV 89117
Phone (702) 483-7367

Ownership & related parties

Parent organization (reported in NPPES) 1

This organization reports itself as a subpart in NPPES; the parent’s legal name matches this organization in the same state.

Practitioners & affiliated clinicians

Practitioners 21

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

View all 21

NPI Registry JSON

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

{
    "created_epoch": "1277683200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1474243200000",
    "number": "1972814630",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6879 W CHARLESTON BLVD",
            "address_2": "SUITE A",
            "city": "LAS VEGAS",
            "state": "NV",
            "postal_code": "891171672",
            "telephone_number": "702-308-4807",
            "fax_number": "702-479-7173"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6879 W CHARLESTON BLVD",
            "address_2": "SUITE A",
            "city": "LAS VEGAS",
            "state": "NV",
            "postal_code": "891171672",
            "telephone_number": "702-308-4807",
            "fax_number": "702-479-7173"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BERGDALE & HALL, LLC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "BERGDALE & HALL, LLC",
        "enumeration_date": "2010-06-28",
        "last_updated": "2016-09-19",
        "status": "A",
        "authorized_official_last_name": "BERGDALE",
        "authorized_official_first_name": "SOMMER",
        "authorized_official_middle_name": "THYME",
        "authorized_official_title_or_position": "CO-OWNER",
        "authorized_official_telephone_number": "702-376-0024",
        "authorized_official_credential": "MA."
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Social Worker, Clinical",
            "state": "NV",
            "license": "5554-C",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Serenity Counseling and Support Services",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Las Vegas, NV

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 19, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.