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MR. MICHAEL ALVIN BERGONDO MSW

Clinical >> Social Worker >> Behavioral Health & Social Service Providers

Registrant NPI Number: 1629320239

Individual Registrant:
MR. MICHAEL ALVIN BERGONDO MSW
Gender: M
Not Sole Proprietor

Location and contact information for practice:
1100 CARSON AVE SUITE 104 LA JUNTA, CO 81050-2751 US
Tel: 719-383-5195  Fax: --

Contact information for business:
2135 FOWLER ST  CANON CITY, CO 81212-3927 US
Tel: 719-269-9296  Fax: --

Registration Information:
NPI: 1629320239
Entity Type: Individual

Specialty information:

PrimaryCodeCategory/DescriptionStateLicense Number
Y1041C0700XBehavioral Health & Social Service Providers
Social Worker
Clinical
CO992947

Legacy codes, insurance codes and state license numbers:

IssuerNumberStateType




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