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General NPI Number Information
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NPI Number | 1780924183
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Entity Type | Individual
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Provider Name | BRETT BERGVALL LPC
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Gender | Male
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Dates
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Enumeration Date | 02/21/2013
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Last Update Date | 08/05/2015
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Provider Practice Location Address
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Address Line | 7146 HIGHWAY 60
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City | WALLIS
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State | TX
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Zip | 77485-9507
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Country | US
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Telephone | 979-217-1581
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Fax | 979-217-1607
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Provider Business Mailing Address
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Address Line | PO BOX 517
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City | WALLIS
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State | TX
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Zip | 77485-0517
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Country | US
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Telephone | 979-451-3809
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Fax | 979-217-1607
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | 67988
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License Number State | TX
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