Amanda Kay Fackler Wallace, LPC

Primary specialty

Professional CounselorTaxonomy code 101YP2500X

License

6401224616 Issued in MI

Practice address

8480 N 32ND St Unit 92
Richland, MI 49083-9817

Phone

(269) 215-5753

NPI assigned

Jan 24, 2023

Last updated

Feb 25, 2026By the provider in NPPES

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Enrolled in MI

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: No
• Power mobility devices: No
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Specialty

Mental Health Counselor

Education

Other, 2022

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Partners in Change Psychological and Community Services, PLCGroup PAC ID 7719050814, 19 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Partners in Change: Psychological & Community Services, PLC

  • Psychologist
  • Midland, MI
  • NPI 1093984817
  Medicare reassignment Care Compare group NPD
• Best Life Counseling and Consultation LLC

  • Counselor
  • Richland, MI
  • NPI 1073384350
  Medicare reassignment NPD
• Aligned Counseling

  • Mental Health Counselor
  • Roscommon, MI
  • NPI 1780400580
  NPD

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1674518400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1771977600000",
    "number": "1023724127",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5228 LOVERS LN STE 102",
            "city": "PORTAGE",
            "state": "MI",
            "postal_code": "490021521",
            "telephone_number": "810-837-2046"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "8480 N 32ND ST UNIT 92",
            "city": "RICHLAND",
            "state": "MI",
            "postal_code": "490839817",
            "telephone_number": "269-215-5753"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "115 N 2nd St",
            "address_purpose": "LOCATION",
            "city": "Roscommon",
            "state": "MI",
            "postal_code": "486539209",
            "country_code": "US",
            "telephone_number": "810-837-2046",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "WALLACE",
        "first_name": "AMANDA",
        "middle_name": "KAY FACKLER",
        "credential": "LPC",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2023-01-24",
        "last_updated": "2026-02-25",
        "certification_date": "2026-02-25",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YM0800X",
            "taxonomy_group": "",
            "desc": "Counselor, Mental Health",
            "state": "MI",
            "license": "6451022560",
            "primary": false
        },
        {
            "code": "101YP2500X",
            "taxonomy_group": "",
            "desc": "Counselor, Professional",
            "state": "MI",
            "license": "6401224616",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Trilogy Orthopedic Supply, Inc.
• Todd Duane Tucker, DDS
• Tracey S Tucker, DDS
• Joshua Vanderwall, MD
• Sally Vellenga
• Stacey Watson
• Jonathan Michael Weiss, M.D.
• Chad Robert Westmaas, LPC
• Jacqueline Allen Wunderly, M.D.
• Kathryn Joy Zimont, RPH

• Professional Counselor in Richland, MI
• Providers in Richland, MI by specialty
• Professional Counselor in Michigan

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 25, 2026; 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.

Verify at the official NPI Registry.