MEDICARE: STILLMIND 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	363LP0808X	Psychiatric/Mental Health Nurse Practitioner

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	8S1497	OTHER	TX	MEDICARE

General Provider Information

NPI Number	:	1619830668
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	STILLMIND LLC

Provider Business Mailing Address
First Line	:	10807 CAPELLA CREEK WAY
Second Line	:
City	:	RICHMOND
State	:	TX
Zip	:	77406-3457
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	24 GREENWAY PLZ STE 1888
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77046-2401
Country	:	US
Telephone Number	:	971-350-6955
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	LAURA PETERSON
Credential	:
Telephone Number	:	971-350-6955

Provider Enumeration Date	:	12/06/2025
Last Update Date	:	04/21/2026

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Directions to “STILLMIND LLC ” Practice Location

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