Provider Demographics
NPI:1851636161
Name:BERG, SUSAN (LPC)
Entity type:Individual
Prefix:
First Name:SUSAN
Middle Name:
Last Name:BERG
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 1:662 N NEW BALLAS RD
Mailing Address - Street 2:
Mailing Address - City:CREVE COEUR
Mailing Address - State:MO
Mailing Address - Zip Code:63141-6737
Mailing Address - Country:US
Mailing Address - Phone:314-503-6966
Mailing Address - Fax:314-993-0777
Practice Address - Street 1:662 N NEW BALLAS RD
Practice Address - Street 2:
Practice Address - City:CREVE COEUR
Practice Address - State:MO
Practice Address - Zip Code:63141-6737
Practice Address - Country:US
Practice Address - Phone:314-503-6966
Practice Address - Fax:314-993-0777
Is Sole Proprietor?:Yes
Enumeration Date:2012-11-28
Last Update Date:2014-05-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health