Provider Demographics
NPI:1972814630
Name:BERGDALE & HALL, LLC
Entity type:Organization
Organization Name:BERGDALE & HALL, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CO-OWNER
Authorized Official - Prefix:
Authorized Official - First Name:SOMMER
Authorized Official - Middle Name:THYME
Authorized Official - Last Name:BERGDALE
Authorized Official - Suffix:
Authorized Official - Credentials:MA
Authorized Official - Phone:702-376-0024
Mailing Address - Street 1:6879 W CHARLESTON BLVD
Mailing Address - Street 2:SUITE A
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89117-1672
Mailing Address - Country:US
Mailing Address - Phone:702-308-4807
Mailing Address - Fax:702-479-7173
Practice Address - Street 1:6879 W CHARLESTON BLVD
Practice Address - Street 2:SUITE A
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89117-1672
Practice Address - Country:US
Practice Address - Phone:702-308-4807
Practice Address - Fax:702-479-7173
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:BERGDALE & HALL, LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2010-06-28
Last Update Date:2016-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV5554-C1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty