JERRYD WALLACE LPC NPI 1821573387

NPI Information

NPI: 1821573387
Provider Name: JERRYD WALLACE, LPC
Classification: Counselor - 101YP2500X
Entity Type: Individual

Specialization: Professional

PECOS Registration: Yes

Address:
162 N. DALLAS AVE
VAN ALSTYNE, TX
ZIP 75495
Phone: (469) 667-3515
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Jerryd Wallace, LPC is a professional counselor in Van Alstyne, TX. Jerryd Wallace, LPC NPI is 1821573387. The provider is registered as an individual entity type.

The NPPES NPI record indicates the provider is a male.

The provider's business location address is:

162 N. DALLAS AVE
VAN ALSTYNE, TX
ZIP 75495-549
Phone: (469) 667-3515

The NPI 1821573387 is registered in the Medicare Provider, Enrollment, Chain and Ownership System (PECOS). The provider is legally eligible to order and refer Part B (Clinical Laboratory and Imaging), Durable Medical Equipment.

The enumeration date for this NPI number is 10/1/2018 and was last updated on 10/1/2018.

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	101YP2500X	Counselor	Professional	77418	TEXAS	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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