Bergeron, Derek

Bergeron, Derek is an individual health care provider with primary practice located at 1650 Cochrane Cir Evans Army Community Hospital, Fort Carson CO 80913. He recently has only one registered license in Behavioral Health & Social Service Providers / Clinical, which is considered as his primary health care specialty. Bergeron, Derek can be contacted via phone (719) 503-7920.

Contact Information

Primary practice address
1650 Cochrane Cir Evans Army Community Hospital Fort Carson CO 80913
Phone: (719) 503-7920
Fax:
Website:
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Health care specialties

SpecialtyCodeLicense #State
Behavioral Health & Social Service Providers / Clinical 103TC0700X PSY.0004175 Colorado

Profile Details

NPI number 1477841823
LBN Legal business name Bergeron, Derek
Credentials PH.D
Entity Individual
Sole proprietor 1 No
Enumeration date Jul 19th, 2011
Last updated Feb 21st, 2024 - about 9 months ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1477841823 NPPES
Texas MEDICAID 2865917

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