DOUGLAS A. BERGSTROM, PH.D., PLLC
NPI 1154501682
Community/Behavioral Health in Prescott, AZ

Q: What is Douglas A. Bergstrom, Ph.D., PLLC's NPI number?

The NPI number for Douglas A. Bergstrom, Ph.D., PLLC is 1154501682. It was assigned to this organization in the NPPES registry on November 13, 2007.

Q: What is Douglas A. Bergstrom, Ph.D., PLLC's specialty?

The primary specialty registered for this NPI is Community/Behavioral Health with taxonomy code 251S00000X.

Active since November 13, 2007

143 E MERRITT ST, PRESCOTT, AZ 86301(928) 445-3835(928) 445-7071 Get Directions Write a Review

NPPES record last updated: November 13, 2007. Verified against the NPPES registry weekly; last sync: October 18, 2026.

On this page

About Douglas A. Bergstrom, Ph.d., Pllc NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

DOUGLAS A. BERGSTROM, PH.D., PLLC (NPI 1154501682) is a healthcare organization registered as a community/behavioral health in Prescott, Arizona and active in the NPI registry since November 2007. The organization lists Douglas Alan Bergstrom, Psychologist, as its authorized official.

NPPES Registry Identity

NPI1154501682

Entity TypeOrganization

Primary Taxonomy251S00000X

Legal Business NameDOUGLAS A. BERGSTROM, PH.D., PLLC

Location Address143 E MERRITT STPrescott, AZ 86301-2028

Mailing Address143 E Merritt StPrescott, AZ 86301-2028 · (928) 445-3835 · Fax (928) 445-7071

Phone(928) 445-3835

Fax(928) 445-7071

Organization SubpartNo

Authorized OfficialDouglas Alan BergstromPsychologist · (928) 445-3835

Enumeration DateNovember 13, 2007

✔ NPI 1154501682 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyCommunity/Behavioral HealthAgencies

Taxonomy Code251S00000X

License✔ Licensed in AZ · 1142

Definition

A private or public agency usually under local government jurisdiction, responsible for assuring the delivery of community based mental health, intellectual disabilities, substance abuse and/or behavioral health services to individuals with those disabilities. Services may range from companion care, respite, transportation, community integration, crisis intervention and stabilization, supported employment, day support, prevocational services, residential support, therapeutic and supportive consultation, environmental modifications, intensive in-home therapy and day treatment, in addition to traditional mental health and behavioral treatment.

143 E MERRITT ST, Prescott, AZ 86301

Open in Google Maps ↗

Medicare Participation & PECOS CMS

Medicare enrollment and the clinicians who bill Medicare through this organization, from CMS.

Medicare Enrollment Status

✔

Enrolled in Medicare (PECOS)

Douglas A. Bergstrom, Ph.d., Pllc is registered in the CMS Provider Enrollment, Chain and Ownership System (PECOS).

Clinicians Billing Medicare Through This Organization

Medicare enrollment records show 1 clinician reassigns Medicare billing to Douglas A. Bergstrom, Ph.D., PLLC, which bills Medicare for the services this clinician delivers.

Clinician (1)

Douglas Bergstrom, PH.D.

Clinical Psychologist

NPI 1063536688

143 E MERRITT ST
Prescott, AZ 86301

(928) 445-3835

✔ PECOS✔ Accepts MedicareSame address

Source: CMS Revalidation Reassignment List, October 2026 release. Reassignment records can lag staffing changes; confirm a current affiliation with the organization.

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Douglas A. Bergstrom, Ph.D., PLLC's NPI number?

The NPI number for Douglas A. Bergstrom, Ph.D., PLLC is 1154501682. It was assigned to this organization in the NPPES registry on November 13, 2007.

Where is Douglas A. Bergstrom, Ph.D., PLLC located?

Douglas A. Bergstrom, Ph.D., PLLC is located at 143 E Merritt St, Prescott, AZ 86301. The listed phone number is (928) 445-3835.

What is Douglas A. Bergstrom, Ph.D., PLLC's specialty?

The primary specialty registered for this NPI is Community/Behavioral Health with taxonomy code 251S00000X.

Is Douglas A. Bergstrom, Ph.D., PLLC enrolled in Medicare?

Yes. Douglas A. Bergstrom, Ph.D., PLLC is registered in the Medicare PECOS enrollment system.

How many clinicians bill Medicare through Douglas A. Bergstrom, Ph.D., PLLC?

According to the CMS Revalidation Reassignment List (October 2026 release), 1 clinician (Clinical Psychologist) reassigns their Medicare billing to Douglas A. Bergstrom, Ph.D., PLLC. A reassignment is filed with Medicare on form CMS-855R, signed by both the clinician and the organization, and lets the organization bill Medicare and receive payment for the clinician's services. Reassignment records can lag staffing changes; confirm a current affiliation with the organization.

When was this NPI record last updated?

The NPPES record for Douglas A. Bergstrom, Ph.D., PLLC was last updated on November 13, 2007. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 18 years ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.