Individual
ELIZABETH BERGMAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
635 MAIN ST, GENOA, OH 43430-1635
(419) 461-1983
(419) 461-3516
Mailing address
217 E 11TH ST, GENOA, OH 43430-1411
(419) 461-1983
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
C.1800896
OH
101YP2500X
Professional Counselor
Primary
E.2001932
OH
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0266112
—
OH
Enumeration date
01/23/2018
Last updated
08/03/2021
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