MEDICARE: STILL WATERS COUNSELING AND CONSULTING, LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YM0800X	Mental Health Counselor

General Provider Information

NPI Number	:	1588595714
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	STILL WATERS COUNSELING AND CONSULTING, LLC

Provider Business Mailing Address
First Line	:	17625 EL CAMINO SUITE 490
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77058
Country	:	US
Telephone Number	:	979-451-3809
Fax Number	:

Provider Business Practice Location Address
First Line	:	17625 EL CAMINO SUITE 490
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77058
Country	:	US
Telephone Number	:	979-451-3809
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	BRETT BERGVALL
Credential	:	LPC-S
Telephone Number	:	979-451-3809

Provider Enumeration Date	:	05/27/2026
Last Update Date	:	05/27/2026

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