Provider Demographics
NPI:1588483739
Name:BERGSTROM, BRYAN JAMES (LMFT)
Entity type:Individual
Prefix:
First Name:BRYAN
Middle Name:JAMES
Last Name:BERGSTROM
Suffix:
Gender:
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16114 E INDIANA AVE STE 210
Mailing Address - Street 2:
Mailing Address - City:SPOKANE VALLEY
Mailing Address - State:WA
Mailing Address - Zip Code:99216-1874
Mailing Address - Country:US
Mailing Address - Phone:509-761-6587
Mailing Address - Fax:360-326-7224
Practice Address - Street 1:16114 E INDIANA AVE STE 210
Practice Address - Street 2:
Practice Address - City:SPOKANE VALLEY
Practice Address - State:WA
Practice Address - Zip Code:99216-1874
Practice Address - Country:US
Practice Address - Phone:509-761-6587
Practice Address - Fax:360-326-7224
Is Sole Proprietor?:No
Enumeration Date:2024-10-05
Last Update Date:2025-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALF61629246106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist