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Individual

BRENDA R BERG

Active
Sole proprietor
No

Provider details

NPI number
Gender
F
Credential
LCSW

Contact information

Practice address
5282 W 250 S, RUSSIAVILLE, IN 46979-9412
(765) 883-7873
(765) 883-7714
Mailing address
5282 W 250 S, RUSSIAVILLE, IN 46979-9412
(765) 883-7873
(765) 883-7714

Taxonomy

Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
IN
1041C0700X
Clinical Social Worker
Primary
34004853A
IN
106H00000X
Marriage & Family Therapist
IN

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
000000390310
ANTHEM
IN
Enumeration date
09/22/2005
Last updated
05/28/2008
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