Organization Name: | MISTY SCOTT BERT |
NPI Number: | 1407218993 |
Entity Type Code: | Organizational (2) |
Authorized Official Name: | MISTY SCOTT BERT (PROFESSIONAL COUNSELOR) |
Mailing Address: | 32 E Main St Forsyth |
State: | GA US |
Postal Code: | 310291839 |
Phone Number: | 4702363478 |
Fax Number: | |
NPI Enumeration Date: | 03/23/2016 |
NPI Last Update Date: | 03/23/2016 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 101YP2500X |
License Number: | LPC008838 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | GA |
Taxonomy Type: | Behavioral Health & Social Service Providers |
Taxonomy Classification: | Counselor |
Taxonomy Specialization: | Professional |
Taxonomy Definition: |