Provider Information for 1881767549
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Mr. CARLISLE E BERGQUIST LCMFT
Sex: Male
NPI: 1881767549
Last Updated: 2007-12-01
Certification Date:
Certification Date:
Details
| Name | Value | ||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| NPI | 1881767549 | ||||||||||||
| Enumeration Date | 2006-11-17 | ||||||||||||
| NPI Type | NPI-1 Individual | ||||||||||||
| Sole Proprietor | NO | ||||||||||||
| Status | Active | ||||||||||||
| Mailing Address | 901 W SOUTH ST SALINA, KS 67401-4053 United States Phone: 785-827-1835 | Fax:785-493-8008 | ||||||||||||
| Primary Practice Address | 901 W SOUTH ST SALINA, KS 67401-4053 United States Phone: 785-827-1835 | Fax:785-493-8008 | ||||||||||||
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