Provider Demographics
NPI:1144967506
Name:BERGER, KYLIE (LPCC)
Entity type:Individual
Prefix:
First Name:KYLIE
Middle Name:
Last Name:BERGER
Suffix:
Gender:F
Credentials:LPCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3103 E CALGARY AVE APT 305
Mailing Address - Street 2:
Mailing Address - City:BISMARCK
Mailing Address - State:ND
Mailing Address - Zip Code:58503-1340
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:801 E MAIN AVE STE F
Practice Address - Street 2:
Practice Address - City:BISMARCK
Practice Address - State:ND
Practice Address - Zip Code:58501-4502
Practice Address - Country:US
Practice Address - Phone:701-751-5858
Practice Address - Fax:701-751-5866
Is Sole Proprietor?:No
Enumeration Date:2022-05-17
Last Update Date:2023-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ND1092-10-15-20A101YP2500X
ND1092-10-15-20-501101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional