Provider Demographics
NPI:1144743022
Name:BERGEN, KATHLEEN RUTH (LMFT)
Entity type:Individual
Prefix:MS
First Name:KATHLEEN
Middle Name:RUTH
Last Name:BERGEN
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:MS
Other - First Name:KATHLEEN
Other - Middle Name:RUTH
Other - Last Name:BERGEN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LMFT
Mailing Address - Street 1:2001 N VAN NESS BLVD
Mailing Address - Street 2:
Mailing Address - City:FRESNO
Mailing Address - State:CA
Mailing Address - Zip Code:93704-6014
Mailing Address - Country:US
Mailing Address - Phone:559-704-1758
Mailing Address - Fax:
Practice Address - Street 1:2001 N VAN NESS BLVD
Practice Address - Street 2:
Practice Address - City:FRESNO
Practice Address - State:CA
Practice Address - Zip Code:93704-6014
Practice Address - Country:US
Practice Address - Phone:559-704-1758
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-07-21
Last Update Date:2025-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA99895106H00000X, 106H00000X
CAPSCY20546103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
No103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical