Individual
EMILY DIANE BERGSTROM
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LPC
Contact information
Practice address
2365 N 34TH ST, BOISE, ID 83703-5523
(208) 473-8205
Mailing address
2365 N 34TH ST, BOISE, ID 83703-5523
(208) 473-8205
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
LPC-6167
ID
Other
Enumeration date
01/18/2020
Last updated
01/18/2020
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