Provider Information for 1972814630
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BERGDALE & HALL, LLC
Other Names:Doing Business As:SERENITY COUNSELING AND SUPPORT SERVICESOrganization Subpart: YES
NPI: 1972814630
Last Updated: 2016-09-19
Certification Date:
Certification Date:
Details
| Name | Value | ||||||||
|---|---|---|---|---|---|---|---|---|---|
| NPI | 1972814630 | ||||||||
| Enumeration Date | 2010-06-28 | ||||||||
| NPI Type | NPI-2 Organization | ||||||||
| Status | Active | ||||||||
| Authorized Official Information | Name: SOMMER THYME BERGDALE MA. Title: Co-Owner Phone: 7023760024 | ||||||||
| Mailing Address | 6879 W CHARLESTON BLVD SUITE A LAS VEGAS, NV 89117-1672 United States Phone: 702-308-4807 | Fax:702-479-7173 | ||||||||
| Primary Practice Address | 6879 W CHARLESTON BLVD SUITE A LAS VEGAS, NV 89117-1672 United States Phone: 702-308-4807 | Fax:702-479-7173 | ||||||||
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