Angel Wallis, LPC

Primary specialty

Professional CounselorTaxonomy code 101YP2500X

License

P0402010 Issued in AR

Practice address

1815 Pleasant Grove Rd
Jonesboro, AR 72405-7870

Phone

(870) 933-6886

Fax

(870) 336-1339

NPI assigned

Mar 29, 2007

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other names 1

• Mrs. Angel Parnell Former name

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

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

{
    "created_epoch": "1175126400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1701043200000",
    "number": "1093835688",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1815 PLEASANT GROVE RD",
            "city": "JONESBORO",
            "state": "AR",
            "postal_code": "724057870",
            "telephone_number": "870-933-6886",
            "fax_number": "870-336-1339"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1815 PLEASANT GROVE RD",
            "city": "JONESBORO",
            "state": "AR",
            "postal_code": "724057870",
            "telephone_number": "870-933-6886",
            "fax_number": "870-336-1339"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WALLIS",
        "first_name": "ANGEL",
        "name_prefix": "Ms.",
        "credential": "LPC",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2007-03-29",
        "last_updated": "2023-11-27",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YP2500X",
            "taxonomy_group": "",
            "desc": "Counselor, Professional",
            "state": "AR",
            "license": "P0402010",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "ANGEL",
            "last_name": "PARNELL",
            "prefix": "MRS.",
            "credential": "LPC",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Jason David Wallace
• Latoya Wallace
• Pamela Wallace
• Patti Wallace
• Willie Wallace
• Shainna Wallis, MCD, CFY-SLP
• Jessica Rogers Walls, APRN, FNP
• Pat Walls, LMSW
• Walmart Inc.
• Walmart Inc.

• Professional Counselor in Jonesboro, AR
• Providers in Jonesboro, AR by specialty
• Professional Counselor in Arkansas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 27, 2023; 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.