Active NPI
Brett Bergvall, LPC
- Professional Counselor
- Wallis, TX
National Provider Identifier
1780924183
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Professional Counselor
- License
- 67988
- Practice address
- 7146 Highway 60
Wallis, TX 77485-9507 - Phone
- (979) 217-1581
- Fax
- (979) 217-1607
- NPI assigned
- Feb 21, 2013
- Last updated
- Aug 5, 2015
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Professional Counselor | 101YP2500X | 67988 | TX | Primary |
Addresses
Primary practice location
7146 Highway 60
Wallis, TX 77485-9507
Mailing address
PO Box 517
Wallis, TX 77485-0517
Phone (979) 451-3809
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 67988 | TX | MD | Social Worker |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Still Waters Counseling and Consulting, LLC | Current | Accepting new patients | |
| Prairie Harbor, LLC | Past | Accepting new patients |
Organizations & group practices 2
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.
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-
- Emotionally Disturbed Childrens' Residential Treatment Facility
- Wallis, TX
- NPI 1235565797
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1361404800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1438732800000",
"number": "1780924183",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 517",
"city": "WALLIS",
"state": "TX",
"postal_code": "774850517",
"telephone_number": "979-451-3809",
"fax_number": "979-217-1607"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "7146 HIGHWAY 60",
"city": "WALLIS",
"state": "TX",
"postal_code": "774859507",
"telephone_number": "979-217-1581",
"fax_number": "979-217-1607"
}
],
"practiceLocations": [],
"basic": {
"last_name": "BERGVALL",
"first_name": "BRETT",
"credential": "LPC",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2013-02-21",
"last_updated": "2015-08-05",
"status": "A"
},
"taxonomies": [
{
"code": "101YP2500X",
"taxonomy_group": "",
"desc": "Counselor, Professional",
"state": "TX",
"license": "67988",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Wallis, TX
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 5, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.