Brett Bergvall, LPC
Individual provider Active NPI Professional Counselor · Wallis, TX
NPI 1780924183 · NPPES record last updated Aug 5, 2015
Key facts
- NPI
- 1780924183
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Professional Counselor 101YP2500X
- License
- 67988 (TX)
- Practice address
- 7146 Highway 60
Wallis, TX 77485-9507 - Phone
- (979) 217-1581
- Fax
- (979) 217-1607
- NPI assigned
- Feb 21, 2013
- Sex
- Male
- Sole proprietor
- No
Organizations & group practices 2
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
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 |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Professional Counselor | 101YP2500X | 67988 | TX | Yes |
Addresses
Primary practice location
7146 Highway 60
Wallis, TX 77485-9507
Mailing address
PO Box 517
Wallis, TX 77485-0517
Phone (979) 451-3809
Other providers in Wallis, TX
- Added Incentive
- Luz Alquicira
- Lindsey Bartay
- Cahrmc, LLC
- Deborah Lynn Carlton
- Comprehensive Counseling
- Susie Cone
- Melanie Renee Graybill
All providers in Wallis, TX · Professional Counselor in Texas
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Aug 5, 2015. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.