Individual
DOUGLAS ALAN BERGSTROM
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
PH.D.
Contact information
Practice address
143 E MERRITT ST, PRESCOTT, AZ 86301-2028
(928) 445-3835
(928) 445-7071
Mailing address
143 E MERRITT ST, PRESCOTT, AZ 86301-2028
(928) 445-3835
(928) 445-7071
Taxonomy
Speciality
Code
Description
License number
State
103TC0700X
Clinical Psychologist
Primary
1142
AZ
Other
Enumeration date
03/19/2007
Last updated
07/08/2007
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