1629316658 NPI number — DR. DEBORAH BERGHUIS PHD, LPC, LPCC

Table of content: DR. DEBORAH BERGHUIS PHD, LPC, LPCC (NPI 1629316658)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1629316658 NPI number — DR. DEBORAH BERGHUIS PHD, LPC, LPCC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
BERGHUIS
Provider First Name:
DEBORAH
Provider Middle Name:
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
PHD, LPC, LPCC
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1629316658
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
09/26/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 7146
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
BOULDER
Provider Business Mailing Address State Name:
CO
Provider Business Mailing Address Postal Code:
80306-7146
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
937-344-3939
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3208 LAKE PARK WAY APT 302
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
LONGMONT
Provider Business Practice Location Address State Name:
CO
Provider Business Practice Location Address Postal Code:
80503-7804
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
937-344-3939
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
01/25/2013

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 101YP2500X , with the licence number:  E.1800686 , registered in the state of OH ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 101YP2500X , with the licence number: LPC.0016707 , registered in the state of CO ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: E.1800686 . This is a "CSWMFT BOARD" identifier , issued by the state of ( OH ) . This identifiers is of the category "OTHER".
  • Identifier: LPC.0016707 . This is a "COLORADO DEPARTMENT OF REGULATORY AGENCIES DIVISION OF PROFESSIONS AND OCCUPATIO" identifier , issued by the state of ( CO ) . This identifiers is of the category "OTHER".
  • Identifier: LPC.0016707 . This is a "STATE BOARD OF LICENSED PROFESSIONAL COUNSELOR EXAMINERS" identifier , issued by the state of ( CO ) . This identifiers is of the category "OTHER".




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