Provider Demographics
NPI:1427396555
Name:BERGMANN, JESSICA A (LMFT)
Entity type:Individual
Prefix:
First Name:JESSICA
Middle Name:A
Last Name:BERGMANN
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:JESSICA
Other - Middle Name:A
Other - Last Name:JONES
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:803 S MAIN ST
Mailing Address - Street 2:
Mailing Address - City:WAUKOMIS
Mailing Address - State:OK
Mailing Address - Zip Code:73773-4241
Mailing Address - Country:US
Mailing Address - Phone:505-991-5258
Mailing Address - Fax:
Practice Address - Street 1:803 S MAIN ST
Practice Address - Street 2:
Practice Address - City:WAUKOMIS
Practice Address - State:OK
Practice Address - Zip Code:73773-4241
Practice Address - Country:US
Practice Address - Phone:505-991-5258
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-01-24
Last Update Date:2024-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
106H00000X
OKLMFT01102106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist