Provider Demographics
NPI:1316418411
Name:STARKE, BERGEN S (LMHC)
Entity type:Individual
Prefix:
First Name:BERGEN
Middle Name:S
Last Name:STARKE
Suffix:
Gender:F
Credentials:LMHC
Other - Prefix:
Other - First Name:BERGEN
Other - Middle Name:S
Other - Last Name:STARKE
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:CDP
Mailing Address - Street 1:PO BOX 960
Mailing Address - Street 2:
Mailing Address - City:BREMERTON
Mailing Address - State:WA
Mailing Address - Zip Code:98337-0212
Mailing Address - Country:US
Mailing Address - Phone:360-337-3776
Mailing Address - Fax:360-373-2096
Practice Address - Street 1:616 6TH ST
Practice Address - Street 2:
Practice Address - City:BREMERTON
Practice Address - State:WA
Practice Address - Zip Code:98337-1420
Practice Address - Country:US
Practice Address - Phone:360-377-3776
Practice Address - Fax:360-373-2096
Is Sole Proprietor?:No
Enumeration Date:2018-12-16
Last Update Date:2021-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA00005653101YA0400X
WA60753545101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA030279Medicaid