Donna Louise Martin-Wallace, LPCC, LADC, ADCR-MN

Primary specialty

Mental Health CounselorTaxonomy code 101YM0800X

License

CC03103 Issued in MN

Practice address

2970 Judicial Rd Ste 100
Burnsville, MN 55337-7822

Phone

(952) 224-8990

Fax

(952) 224-8991

NPI assigned

Jan 13, 2022

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": "1642032000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1642032000000",
    "number": "1083365811",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "14024 NATCHEZ AVE",
            "city": "SAVAGE",
            "state": "MN",
            "postal_code": "553782002",
            "telephone_number": "612-220-3247"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2970 JUDICIAL RD STE 100",
            "city": "BURNSVILLE",
            "state": "MN",
            "postal_code": "553377822",
            "telephone_number": "952-224-8990",
            "fax_number": "952-224-8991"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MARTIN-WALLACE",
        "first_name": "DONNA",
        "middle_name": "LOUISE",
        "credential": "LPCC, LADC, ADCR-MN",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2022-01-13",
        "last_updated": "2022-01-13",
        "certification_date": "2022-01-13",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YM0800X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Counselor, Mental Health",
            "state": "MN",
            "license": "CC03103",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Vicki C Markhart, SLP MS CCC SLP
• Laura Markstrom, M.S. CFY-SLP
• Megan Lea Marlar
• Joanne Ruth Marsh, CNP
• Genesis Lynn Marshall
• Angela Jeanine Martin, RN
• Jaime Ellen Kuper Martin, MA CCC-SLP
• Patrick J Martin
• Amy Martinez, PT
• Marty-McDonald Health Services, P.a.

• Mental Health Counselor in Burnsville, MN
• Providers in Burnsville, MN by specialty
• Mental Health Counselor in Minnesota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 13, 2022; 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.