KEVIN M. BERGSTROM (NPI# 1457863748) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1457863748 |
| Entity Type | Individual |
| Full Name | KEVIN M. BERGSTROM |
| Credential | LCPC |
| Practice Address |
12350 Hall Shop Rd Fulton MD 20759-9774 |
| Mailing Address |
Po Box 339 Ashton MD 20861-0339 |
| Practice Telephone | 8004915369 |
| Practice Fax Number | 3017743678 |
| Mailing Telephone | 8004915369 |
| Mailing Fax Number | 3017743678 |
| Enumeration Date | 2017-10-26 |
| Last Update Date | 2017-10-26 |
| Gender Code | M |
| Is Sole Proprietor | Y |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 101YP2500X |
Counselor Specialization: Professional |
LC7780 | MD | Behavioral Health & Social Service Providers |
| Street Address |
12350 HALL SHOP RD |
| City | FULTON |
| State | MD |
| Zip Code | 20759-9774 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1861873184 | Centrepointe Counseling, Inc. | Counselor | 12350 Hall Shop Rd, Fulton, MD 20759-9774 | 2015-06-11 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1912528274 | Drayer Physical Therapy of Maryland LLC | Clinic/Center | 11710 E Market Place, Suite F, Fulton, MD 20759 | 2020-04-28 |
| 1174081913 | Darrius Humphrey | Counselor | 7625 Wood Lawn Boulevard, Medical Arts Building, Suite Ll50, Laurel, MD 20759 | 2019-03-12 |
| 1578986105 | Total Investment & Marketing, Inc | Assisted Living Facility | 12026 Scaggsville Road, Fulton, MD 20759 | 2014-02-03 |
| 1235489030 | First Sight Vision Care LLC | Clinic/Center | 8160 Maple Lawn Blvd, Suite 140, Fulton, MD 20759 | 2012-09-19 |
| 1669730941 | Urenna Acholonu | Obstetrics & Gynecology | 7625 Maple Lawn Blvd Lowr Lobby, Fulton, MD 20759 | 2012-04-24 |
| 1528228418 | Jill Stern May | Physical Therapist | 11830 W Market Pl Ste D, Fulton, MD 20759 | 2008-06-13 |
| 1750580346 | Standard Medical Home Healthcare, LLC | Home Health | 8115 Maple Lawn Blvd Ste 350, Fulton, MD 20759 | 2007-07-13 |
| 1144388729 | Loretta Sutphin Stenzel | Family Medicine | 8115 Maple Lawn Blvd Ste 140, Fulton, MD 20759 | 2006-12-05 |
| 1659488294 | Tara Guretzky | Ophthalmology | 7625 Maple Lawn Blvd Ste 200, Fulton, MD 20759 | 2006-08-23 |
| 1417327487 | Judith Greengold | Nurse Practitioner | 8115 Maple Lawn Blvd Ste 140, Fulton, MD 20759 | 2015-10-02 |
| Find all providers in zip 20759 | ||||
| Taxonomy Code | 101YP2500X |
| Grouping | Behavioral Health & Social Service Providers |
| Classification | Counselor |
| Specialization | Professional |
| Definition to come... |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1942347406 | Safe Harbor Christian Counseling | Counselor | 8200 Old Columbia Rd, Fulton, MD 20759-2201 | 2007-01-31 |
| 1437234614 | Trudy Lynn Stephens Baker | Counselor | 413 A Court Street, Fulton, MO 65251 | 2006-10-26 |
| 1215018247 | Donna J. Mazyck | Counselor | 11353 Liberty St, Fulton, MD 20759-2511 | 2006-10-17 |
| 1730672932 | Valery Kron | Counselor | 500 Market St Ste 101, Fulton, MO 65251-2808 | 2018-06-12 |
| 1033648795 | Dallas Gipson | Counselor | 2625 Fairway Dr Ste E, Fulton, MO 65251-4023 | 2017-06-07 |
| 1396294443 | Safe Care, LLC | Counselor | 500 Market St, Suite 101, Fulton, MO 65251-2808 | 2016-09-30 |
| 1609253517 | Kim Yost | Counselor | 8160 Maple Lawn Blvd, Suite 200, Fulton, MD 20759-2615 | 2015-04-29 |
| 1144635616 | Marie Celano | Counselor | 8200 Old Columbia Rd, Fulton, MD 20759-2201 | 2014-06-24 |
| 1700161718 | Anne Marie Rulo | Counselor | 2625 Fairway Dr, Fulton, MO 65251-4023 | 2011-10-21 |
| 1740319649 | Cynthia L. Chalfant | Counselor | 2625 Fairway Dr, Suite A, Fulton, MO 65251-3936 | 2007-03-05 |
| Find all providers in FULTON | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.