Individual
KEVIN JAY BERGSTROM
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
1221 W 17TH ST, NORTH PLATTE, NE 69101-2216
(308) 380-9196
Mailing address
6459 S HOMESTEAD RD, NORTH PLATTE, NE 69101-6979
(308) 380-9196
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
12870
NE
Other
Enumeration date
01/19/2022
Last updated
01/19/2022
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