Provider Demographics
NPI:1215045315
Name:BERG, MELVIN R (PHD)
Entity type:Individual
Prefix:DR
First Name:MELVIN
Middle Name:R
Last Name:BERG
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2201 SW 29TH ST
Mailing Address - Street 2:
Mailing Address - City:TOPEKA
Mailing Address - State:KS
Mailing Address - Zip Code:66611-1975
Mailing Address - Country:US
Mailing Address - Phone:785-230-1981
Mailing Address - Fax:785-272-5967
Practice Address - Street 1:2955 SW WANAMAKER DR
Practice Address - Street 2:
Practice Address - City:TOPEKA
Practice Address - State:KS
Practice Address - Zip Code:66614-5318
Practice Address - Country:US
Practice Address - Phone:785-272-5566
Practice Address - Fax:785-272-5967
Is Sole Proprietor?:No
Enumeration Date:2006-08-28
Last Update Date:2020-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS494103TC0700X, 103T00000X, 103TP0814X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
No103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No103TP0814XBehavioral Health & Social Service ProvidersPsychologistPsychoanalysis
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS119659OtherBLUE SHIELD OF KS
KS119659OtherBLUE SHIELD OF KS