Individual
JIM W BERNGEN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
BA/PSRS
Contact information
Practice address
208 GEORGIA PL, POTEAU, OK 74953-2004
(918) 658-3909
Mailing address
208 GEORGIA PL, POTEAU, OK 74953-2004
(918) 658-3909
Taxonomy
Speciality
Code
Description
License number
State
103TR0400X
Rehabilitation Psychologist
Primary
—
OK
Other
Enumeration date
06/03/2010
Last updated
06/03/2010
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