Individual
CLANCY BERGOLD
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
5350 DONALD ST, EUGENE, OR 97405-3529
(541) 505-8558
(541) 505-8558
Mailing address
3587 HEATHROW WAY, MEDFORD, OR 97504-4004
(541) 858-8170
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
—
—
Other
Enumeration date
07/19/2010
Last updated
09/12/2018
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