Basic Information
| Provider Information | |||||||||
| NPI: | 1801252200 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | BERGER | ||||||||
| FirstName: | HEATHER | ||||||||
| MiddleName: | LYNN | ||||||||
| NamePrefix: | MS. | ||||||||
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| Credential: | LPC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1012 S STAPLEY DR | ||||||||
| Address2: | BLD 5 SUITE 117 | ||||||||
| City: | MESA | ||||||||
| State: | AZ | ||||||||
| PostalCode: | 852044270 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4807686022 | ||||||||
| FaxNumber: | 4808310078 | ||||||||
| Practice Location | |||||||||
| Address1: | 1855 W BASELINE RD | ||||||||
| Address2: | SUITE 101 | ||||||||
| City: | MESA | ||||||||
| State: | AZ | ||||||||
| PostalCode: | 852029000 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4808317563 | ||||||||
| FaxNumber: | 4809627671 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/14/2016 | ||||||||
| LastUpdateDate: | 01/14/2016 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YP2500X | LPC15808 | AZ | Y | Behavioral Health & Social Service Providers | Counselor | Professional |
No ID Information.