Individual
REBECCA SUE BERGHORN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LMFT
Contact information
Practice address
3948 NEW VISION DR STE D, FORT WAYNE, IN 46845-1721
(260) 407-7285
(260) 407-0094
Mailing address
3948 NEW VISION DR STE D, FORT WAYNE, IN 46845-1721
(260) 407-7285
(260) 407-0094
Taxonomy
Speciality
Code
Description
License number
State
106H00000X
Marriage & Family Therapist
Primary
35001692
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
200530260A
—
IN
Enumeration date
09/20/2006
Last updated
12/08/2009
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