Marla Kaye Wallace, M.A., PLPC
Individual provider Active NPI Counselor · Creve Coeur, MO
NPI 1013754316 · NPPES record last updated Jul 12, 2024
Key facts
- NPI
- 1013754316
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Counselor 101Y00000X
- License
- 2023046935 (MO)
- Practice address
- 967 Gardenview Office Pkwy
Creve Coeur, MO 63141-5917 - Phone
- (314) 561-9757
- NPI assigned
- Jul 12, 2024
- Sex
- Female
- Sole proprietor
- No
Organizations & group practices 2
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
- Credentials
- Master of Arts
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 2023046935 | MO | MD | Counselor |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| The Center for Mindfulness and CBT, LLC | Current |
Accepting new patients | |
| The Center for Mindfulness and CBT, LLC | Past |
Accepting new patients |
Locations
967 Gardenview Office Pkwy
Saint Louis, MO 63141
Phone (314) 561-9757
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Counselor | 101Y00000X | 2023046935 | MO | Yes |
Addresses
Primary practice location
967 Gardenview Office Pkwy
Creve Coeur, MO 63141-5917
Mailing address
967 Gardenview Office Pkwy
Creve Coeur, MO 63141-5917
Phone (314) 561-9757
Other providers in Creve Coeur, MO
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jul 12, 2024. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.