Provider Demographics
NPI:1902177827
Name:BERGIN, LINDSAY D (LPC)
Entity Type:Individual
Prefix:
First Name:LINDSAY
Middle Name:D
Last Name:BERGIN
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 1:500 THROCKMORTON ST
Mailing Address - Street 2:SUITE 2212
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76102-3708
Mailing Address - Country:US
Mailing Address - Phone:817-729-5587
Mailing Address - Fax:
Practice Address - Street 1:500 THROCKMORTON ST
Practice Address - Street 2:SUITE 2212
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76102-3708
Practice Address - Country:US
Practice Address - Phone:817-729-5587
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-01-24
Last Update Date:2012-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX65250101Y00000X, 101YM0800X, 101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101Y00000XBehavioral Health & Social Service ProvidersCounselor
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health