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MR. MICHAEL ALVIN BERGONDO MSW
Clinical >> Social Worker >> Behavioral Health & Social Service ProvidersRegistrant NPI Number: 1629320239
Individual Registrant:MR. MICHAEL ALVIN BERGONDO MSW
Gender: M
Not Sole Proprietor
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: --
Tel: 719-383-5195 Fax: --
Contact information for business:
2135 FOWLER ST CANON CITY, CO 81212-3927 US
Tel: 719-269-9296 Fax: --
Tel: 719-269-9296 Fax: --
Registration Information:
NPI: 1629320239
Entity Type: Individual
Entity Type: Individual
Specialty information:
| Primary | Code | Category/Description | State | License Number |
|---|---|---|---|---|
| Y | 1041C0700X | Behavioral Health & Social Service Providers Social Worker Clinical | CO | 992947 |
Legacy codes, insurance codes and state license numbers:
| Issuer | Number | State | Type |
|---|---|---|---|
