Gina Thara Wall, LPC

Primary specialty

Professional CounselorTaxonomy code 101YP2500X

License

159747 Issued in AK

Practice address

17601 James Way
Eagle River, AK 99577-9254

Phone

(907) 854-2344

NPI assigned

Jul 17, 2020

Last updated

Jul 17, 2020By the provider in NPPES

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

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

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

{
    "created_epoch": "1594944000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1594944000000",
    "number": "1073121752",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "17601 JAMES WAY",
            "city": "EAGLE RIVER",
            "state": "AK",
            "postal_code": "995779254",
            "telephone_number": "907-854-2344"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "17601 JAMES WAY",
            "city": "EAGLE RIVER",
            "state": "AK",
            "postal_code": "995779254",
            "telephone_number": "907-854-2344"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WALL",
        "first_name": "GINA",
        "middle_name": "THARA",
        "credential": "LPC",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2020-07-17",
        "last_updated": "2020-07-17",
        "certification_date": "2020-07-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YP2500X",
            "taxonomy_group": "",
            "desc": "Counselor, Professional",
            "state": "AK",
            "license": "159747",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Rachel Ann Wagner
• Wal-Mart Stores, Inc. (Vision Center 30-2188)
• Walgreen Co (Walgreens #15362)
• Dennis C Walker
• Terrell Walker
• Rebecca Miller Wall, PHARMD
• Joel Richard Wallace, D.D.S.
• Walmart Inc. (Walmart Pharmacy 10-2188)
• Shelly Waltrip
• Jennifer Ann Watson, M.S. CCC-SLP

• Professional Counselor in Eagle River, AK
• Providers in Eagle River, AK by specialty
• Professional Counselor in Alaska

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 17, 2020; 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.