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Bergdahl Assessment & Psychotherapy, PLLC

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Company Details

Name: Bergdahl Assessment & Psychotherapy, PLLC
Jurisdiction: Idaho
Legal type: Limited Liability Company (D)
Status: Active-Existing
Date of registration: 07 Jul 2020 (5 years ago)
Financial Date End: 31 Jul 2025
Entity Number: 3934155
Place of Formation: IDAHO
File Number: 716476
ZIP code: 83843
County: Latah County
Principal Address: STEPHEN BERGDAHL, PHD 316 S JEFFERSON ST MOSCOW, ID 83843-2936
Mailing Address: STEPHEN BERGDAHL, PHD 2254 WESTVIEW DR MOSCOW, ID 83843-9623

Agent

Name Role Address
Stephen A Bergdahl Agent 316 SOUTH JEFFERSON STREET, MOSCOW, ID 83843

Manager

Name Role Address Appointed On
Stephen Alexander Bergdahl Manager 316 S JEFFERSON ST, MOSCOW, ID 83843 2024-07-22

National Provider Identifier

NPI Number:
1568258457
Certification Date:
2025-04-16

Authorized Person:

Name:
DR. STEPHEN A BERGDAHL
Role:
CLINICAL PSYCHOLOGIST
Phone:

Taxonomy:

Selected Taxonomy:
103TC0700X - Clinical Psychologist
Is Primary:
Yes

Contacts:

Filing

Filing Name Filing Number Filing date
Statement of Change of Business Mailing Address 0006258393 2025-05-16
Annual Report 0005825728 2024-07-22
Application for Reinstatement 0005600561 2024-02-12
Dissolution/Revocation - Administrative 0004455906 2021-10-21
Initial Filing 0003934155 2020-07-07

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Date of last update: 18 May 2025

Sources: Idaho Secretary of State