Douglas A. Bergstrom, Ph.D., PLLC
Community/Behavioral Health in Prescott, AZ. Organization (NPI-2).
Details
- NPI
- 1154501682
- Entity type
- Organization (NPI-2)
- Legal business name
- Douglas A. Bergstrom, Ph.D., PLLC
- Organization subpart
- No
- Enumeration date
- Nov 13, 2007
- Last updated
- Nov 13, 2007
Medicare and OIG
- Medicare enrolled (PECOS)
- Yes · PART B SUPPLIER - CLINIC/GROUP PRACTICE
- Can order and refer
- Not on the CMS order and referring list
- OIG exclusion list
- This NPI is not listed
CMS and OIG files of November 2026. PECOS lookup · OIG exclusion check
Taxonomy and licenses
| Taxonomy code | Description | License | State | Primary |
|---|---|---|---|---|
| 251S00000X | Community/Behavioral Health | 1142 | AZ | Yes |
Practice location
143 E Merritt StPrescott, AZ 86301-2028
Phone 928-445-3835 · Fax 928-445-7071
Mailing address
143 E Merritt StPrescott, AZ 86301-2028
Phone 928-445-3835 · Fax 928-445-7071
Authorized official
Douglas Alan Bergstrom
Psychologist
9284453835
Is something wrong?
This page shows exactly what the provider filed with NPPES. Only the provider (or their surrogate) can change it, by signing in to NPPES. Our page updates within a day of their change. See how to update NPI information.
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All 28 Community/Behavioral Health Agency providers in Prescott · All 2,576 providers in Prescott
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