Active NPI
Stephen James Wallace, LPCC
- Professional Counselor
- Canton, OH
National Provider Identifier
1023399052
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Professional Counselor
- License
- E.1000187
- Practice address
- 625 Cleveland Ave NW
Canton, OH 44702-1805 - Phone
- (330) 453-8252
- Fax
- (330) 453-6716
- NPI assigned
- Sep 3, 2011
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Professional Counselor | 101YP2500X | E.1000187 | OH | Primary |
Addresses
Primary practice location
625 Cleveland Ave NW
Canton, OH 44702-1805
Mailing address
625 Cleveland Ave NW
Canton, OH 44702-1805
Phone (330) 453-8252
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 0168101 | Medicaid | OH |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in OH
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: No
- Power mobility devices: No
- Hospice: No
Enrollment records 1
Care Compare profile
Medicare Care Compare- Specialty
- Mental Health Counselor
- Education
- Other, 2011
- Medicare assignment
- May accept Medicare assignment
Practice addresses (Care Compare)
66 E Flagler St
Miami, FL 33130-1807
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| E.1000187 | OH | MD | Professional Counselor |
Organizations & group practices 1
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1315008000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1488412800000",
"number": "1023399052",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "625 CLEVELAND AVE NW",
"city": "CANTON",
"state": "OH",
"postal_code": "447021805",
"telephone_number": "330-453-8252",
"fax_number": "330-453-6716"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "625 CLEVELAND AVE NW",
"city": "CANTON",
"state": "OH",
"postal_code": "447021805",
"telephone_number": "330-453-8252",
"fax_number": "330-453-6716"
}
],
"practiceLocations": [],
"basic": {
"last_name": "WALLACE",
"first_name": "STEPHEN",
"middle_name": "JAMES",
"credential": "LPCC",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2011-09-03",
"last_updated": "2017-03-02",
"status": "A"
},
"taxonomies": [
{
"code": "101YP2500X",
"taxonomy_group": "",
"desc": "Counselor, Professional",
"state": "OH",
"license": "E.1000187",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "0168101",
"state": "OH"
}
],
"endpoints": [],
"other_names": []
}Other providers in Canton, OH
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 2, 2017; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
- Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.