Provider Demographics
NPI:1366950412
Name:BERTOCH, ADAM MARK (MS, LCDC, LMFT-A)
Entity type:Individual
Prefix:
First Name:ADAM
Middle Name:MARK
Last Name:BERTOCH
Suffix:
Gender:M
Credentials:MS, LCDC, LMFT-A
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:21723 MOSSY FIELD LN
Mailing Address - Street 2:
Mailing Address - City:SPRING
Mailing Address - State:TX
Mailing Address - Zip Code:77388-3647
Mailing Address - Country:US
Mailing Address - Phone:281-356-3605
Mailing Address - Fax:
Practice Address - Street 1:8350 ASHLANE WAY STE 104
Practice Address - Street 2:
Practice Address - City:SPRING
Practice Address - State:TX
Practice Address - Zip Code:77382-2341
Practice Address - Country:US
Practice Address - Phone:832-246-8806
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-01-10
Last Update Date:2018-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX202792106H00000X
TX13545101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Multi-Specialty
No106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Multi-Specialty