Provider Demographics
NPI:1366746737
Name:BERG, ROBIN (MS, LMFT)
Entity type:Individual
Prefix:
First Name:ROBIN
Middle Name:
Last Name:BERG
Suffix:
Gender:F
Credentials:MS, LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:577 38TH AVE W
Mailing Address - Street 2:
Mailing Address - City:WEST FARGO
Mailing Address - State:ND
Mailing Address - Zip Code:58078-8146
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:819 30TH AVE S
Practice Address - Street 2:SUITE 206F
Practice Address - City:MOORHEAD
Practice Address - State:MN
Practice Address - Zip Code:56560-5000
Practice Address - Country:US
Practice Address - Phone:218-284-9672
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-12-29
Last Update Date:2016-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN2289106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN1366746737Medicaid