Provider Demographics
NPI:1386406320
Name:BERGESON, SARAH ANNE (LPC)
Entity type:Individual
Prefix:
First Name:SARAH
Middle Name:ANNE
Last Name:BERGESON
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4101 WATERTOWN PL
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:MO
Mailing Address - Zip Code:65203-6810
Mailing Address - Country:US
Mailing Address - Phone:573-554-5470
Mailing Address - Fax:
Practice Address - Street 1:2503 W ASH ST STE B
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:MO
Practice Address - Zip Code:65203-4612
Practice Address - Country:US
Practice Address - Phone:573-557-5470
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-01-25
Last Update Date:2024-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2022033962101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health