Provider Demographics
NPI:1568258457
Name:BERGDAHL ASSESSMENT & PSYCHOTHERAPY, PLLC
Entity type:Organization
Organization Name:BERGDAHL ASSESSMENT & PSYCHOTHERAPY, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINICAL PSYCHOLOGIST
Authorized Official - Prefix:DR
Authorized Official - First Name:STEPHEN
Authorized Official - Middle Name:A
Authorized Official - Last Name:BERGDAHL
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:559-288-1747
Mailing Address - Street 1:2254 WESTVIEW DR
Mailing Address - Street 2:
Mailing Address - City:MOSCOW
Mailing Address - State:ID
Mailing Address - Zip Code:83843-9623
Mailing Address - Country:US
Mailing Address - Phone:559-288-1747
Mailing Address - Fax:
Practice Address - Street 1:2254 WESTVIEW DR
Practice Address - Street 2:
Practice Address - City:MOSCOW
Practice Address - State:ID
Practice Address - Zip Code:83843-9623
Practice Address - Country:US
Practice Address - Phone:559-288-1747
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-04-16
Last Update Date:2025-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty