Organization
REDEFINE LIFE HOLISTIC PSYCHOTHERAPY, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. JODIE BERGQUIST DPC, LPC-S, LCDC (OWNER/LICENSED PSYCHOTHERAPIST)
(832) 781-2153
Entity
Organization
Contact information
Practice address
5347 E 5TH ST, KATY, TX 77493-2053
(832) 781-2153
Mailing address
5347 E 5TH ST, KATY, TX 77493-2053
(832) 781-2153
Taxonomy
Speciality
Code
Description
License number
State
261QM0801X
Mental Health Clinic/Center (Including Community Mental Health Center)
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1144679697
MENTAL HEALTH
TX
Enumeration date
07/17/2023
Last updated
07/17/2023
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