Individual
MR. MARK WYNN BERGER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
L.C.S.W.
Contact information
Practice address
1002 IDAHO ST, LEWISTON, ID 83501-1938
(208) 746-7661
Mailing address
1002 IDAHO ST, LEWISTON, ID 83501-1938
(208) 798-8744
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
0660722707
—
1041C0700X
Clinical Social Worker
Primary
LCSW-26273
ID
Other
Enumeration date
09/24/2013
Last updated
09/24/2013
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