Nyesha Wallace

Primary specialty

CounselorTaxonomy code 101Y00000X

License

15286 Issued in TX

Practice address

1700 Post Oak Blvd Ste 600
Houston, TX 77056-3973

Phone

(800) 892-2695

NPI assigned

Aug 23, 2021

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Other names 1

• Nyesha Henderson Former name

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

Interoperability endpoints

• FHIR API: https://api.platform.athenahealth.com/23557/brand/1/csg/1/fhir/r4

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

{
    "created_epoch": "1629676800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1629676800000",
    "number": "1053087643",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2960 CAMINO DIABLO",
            "address_2": "STE 105",
            "city": "WALNUT CREEK",
            "state": "CA",
            "postal_code": "945973945"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1700 POST OAK BLVD STE 600",
            "city": "HOUSTON",
            "state": "TX",
            "postal_code": "770563973",
            "telephone_number": "800-892-2695"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WALLACE",
        "first_name": "NYESHA",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2021-08-23",
        "last_updated": "2021-08-23",
        "certification_date": "2021-08-23",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101Y00000X",
            "taxonomy_group": "",
            "desc": "Counselor",
            "state": "TX",
            "license": "15286",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "NYESHA",
            "last_name": "HENDERSON",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Leroy Wallace II, QMHP-CS
• Lindsey Wallace, APN
• Marcy Marie Wallace, LSSP, PA
• Maria Annette Wallace
• Maureen Kay Wallace, RNFA
• Pamela Lindsey Wallace, PT, DPT
• Phyllis Marie Wallace, CRNA
• Rebecca Ann Wallace, MSW
• Rebekah Wallace, LCSW
• Shannon E Wallace

• Counselor in Houston, TX
• Providers in Houston, TX by specialty
• Counselor in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 23, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.