LISA WALLACE NPI 1427463405

NPI Information

NPI: 1427463405
Provider Name: LISA WALLACE
Classification: Counselor - 101YM0800X
Entity Type: Organization

Specialization: Mental Health

Address:
20200 GOVERNORS DR
107
OLYMPIA FIELDS, IL
ZIP 60461
Phone: (708) 462-4235
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LISA WALLACE is a mental health counselor in Olympia Fields, IL. LISA WALLACE NPI is 1427463405. The provider is registered as an organization entity type and is a multi-specialty group.

The provider's business location address is:

20200 GOVERNORS DR
107
OLYMPIA FIELDS, IL
ZIP 60461-032
Phone: (708) 462-4235

The provider's authorized official is Lisa Wallace .
The authorized official title is Provider and has the following contact phone number (708) 906-0205.

The enumeration date for this NPI number is 6/27/2014 and was last updated on 6/27/2014.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No.	Taxonomy Code	Taxonomy Clasification	Taxonomy Specialization	License Number	License State	Primary
1	101Y00000X	Counselor		180.008731	ILLINOIS	No
2	101YA0400X	Counselor	Addiction (Substance Use Disorder)	180.008731	ILLINOIS	No
3	101YP1600X	Counselor	Pastoral	180.008731	ILLINOIS	No
4	101YP2500X	Counselor	Professional	180.008731	ILLINOIS	No
5	106H00000X	Marriage & Family Therapist		180.008731	ILLINOIS	No
6	101YM0800X	Counselor	Mental Health	180.008731	ILLINOIS	Yes

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 5/5/2024

NPI Synchronization or Removal

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