JACOB P BERGSTEDT (NPI# 1538448766) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1538448766 |
| Entity Type | Individual |
| Full Name | JACOB P BERGSTEDT |
| Credential | IMFT |
| Practice Address |
975 Kingsivew Drive Bldg A Lebanon OH 45036-9562 |
| Mailing Address |
204 Cook Rd Ste 400 Lebanon OH 45036-9600 |
| Practice Telephone | 5132287800 |
| Practice Fax Number | 5132287846 |
| Mailing Telephone | 5132287800 |
| Mailing Fax Number | 5137252231 |
| Enumeration Date | 2011-08-05 |
| Last Update Date | 2018-05-08 |
| Gender Code | M |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 106H00000X | Marriage & Family Therapist | F-1500003 | OH | Behavioral Health & Social Service Providers |
| Street Address |
975 KINGSIVEW DRIVE BLDG A |
| City | LEBANON |
| State | OH |
| Zip Code | 45036-9562 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1568438497 | Russell W Dern | Psychologist | 975 Kingsivew Drive, Bldg A, Lebanon, OH 45036-9562 | 2006-02-28 |
| 1528513728 | Mandy A Blanton | Case Manager/Care Coordinator | 975 Kingsivew Drive, Bldg B, Lebanon, OH 45036-9562 | 2016-08-18 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1205479458 | Natasha Denney Arentz | Nurse Practitioner | 5787 Oh-63, Lebanon, OH 45036 | 2019-10-21 |
| 1265086573 | Eric Stone | Counselor | 5234 Oh-63, Lebanon, OH 45036 | 2019-07-25 |
| 1548730401 | Crystal Prater | Counselor | 5234 W Sr 63, Lebanon, OH 45036 | 2018-12-04 |
| 1922574284 | Ellen L Fink | Counselor | 5234 Sr 63, Lebanon, OH 45036 | 2018-10-15 |
| 1255832275 | Primary Care Partners of Ohio | Family Medicine | 726 E Main St Ste F205, Lebanon, OH 45036 | 2018-02-25 |
| 1548769599 | Chelsea R Perkins | Case Manager/Care Coordinator | 975 Kingsview Drive Bldg B, Lebanon, OH 45036 | 2018-02-06 |
| 1184133829 | Mary Bennett | Speech-Language Pathologist | 6760 Oh St Rt. 34, Lynchburg, OH 45036 | 2017-09-26 |
| 1699292912 | Robert Earl Offutt | Counselor | 5234 State Rt.63, Lebanon, OH 45036 | 2017-08-28 |
| 1407381528 | Kari Bump | Counselor | 320 E Silver St, Lebanon, OH 45036 | 2017-04-26 |
| 1154780435 | Ohio Department of Rehabilitation and Correction | Public Health or Welfare | State Route 63, Lebanon, OH 45036 | 2016-02-16 |
| Find all providers in zip 45036 | ||||
| Taxonomy Code | 106H00000X |
| Grouping | Behavioral Health & Social Service Providers |
| Classification | Marriage & Family Therapist |
| A marriage and family therapist is a person with a master's degree in marriage and family therapy, or a master's or doctoral degree in a related mental health field with substantially equivalent coursework in marriage and family therapy, who receives supervised clinical experience, or a person who meets the state requirements to practice as a marriage and family therapist. A marriage and family therapist treats mental and emotional disorders within the context of marriage and family systems. A marriage and family therapist provides mental health and counseling services to individuals, couples, families, and groups. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1376051771 | Kelly Lee Ozelski | Marriage & Family Therapist | 752 Willow St, Lebanon, PA 17046-5066 | 2018-01-19 |
| 1326590142 | Natalie Andrews | Marriage & Family Therapist | 767 Columbus Ave Ste 2, Lebanon, OH 45036-1749 | 2016-10-27 |
| 1316393424 | Alice Stricklin | Marriage & Family Therapist | 110 Dawson Ln, Lebanon, TN 37087-3304 | 2016-05-06 |
| 1396123774 | Selma A Sisco | Marriage & Family Therapist | 3 Country Hill Rd, Lebanon, NJ 08833-3022 | 2015-05-18 |
| 1497156186 | River of Hope | Marriage & Family Therapist | 100 Forney Rd, Lebanon, PA 17042-9344 | 2014-09-12 |
| 1154768729 | Jessica Buckley Mccoy | Marriage & Family Therapist | 207 Oakdale Dr, Lebanon, TN 37087-2031 | 2013-05-22 |
| 1508465949 | Annita Michelle Coburn | Marriage & Family Therapist | 610 N. Lebanon St., Lebanon, IN 46052-1716 | 2020-10-17 |
| 1972115475 | Susan Davis | Marriage & Family Therapist | 85 Mechanic St, Lebanon, NH 03766-1537 | 2020-08-18 |
| 1245849413 | Kelly Ozelski LLC | Marriage & Family Therapist | 160 S 22nd St, Lebanon, PA 17042-2559 | 2020-07-23 |
| 1548806417 | Juliette Elizabeth Mcdaniel | Marriage & Family Therapist | 1600 W Main St, Lebanon, IN 46052-2388 | 2019-11-26 |
| Find all providers in LEBANON | ||||
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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.