| Doctor Name: | LESA GAIL BERGMAN |
| NPI Number: | 1003981713 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | LPC |
| License Number: | 2001029221 |
| Business Practice Address: | 206 Centre On The Lk Lake St Louis, MO - 633671370 |
| Business Phone Number: | 6366992165 |
| Business Fax Number: | 6366251633 |
| Mailing Address: | 206 Centre On The Lk, LAKE ST LOUIS |
| State: | MO |
| Postal Code: | 633671370 |
| Phone Number: | 6366992165 |
| Fax Number: | |
| NPI Enumeration Date: | 11/21/2006 |
| NPI Last Update Date: | 01/22/2015 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 101YP2500X |
| License Number: | 2001029221 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | MO |
| Taxonomy Type: | Behavioral Health & Social Service Providers |
| Taxonomy Classification: | Counselor |
| Taxonomy Specialization: | Professional |
| Taxonomy Definition: | |