Active NPI
Tina Marie Jones-Wallace, LPCC
- Professional Counselor
- Morehead, KY
National Provider Identifier
1114250347
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Professional Counselor
- License
- 103796
- Practice address
- 411 Bishop CT
Morehead, KY 40351-1009 - Phone
- (606) 784-2096
- NPI assigned
- Sep 4, 2009
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Professional Counselor | 101YP2500X | 103796 | KY | Primary |
Addresses
Primary practice location
411 Bishop CT
Morehead, KY 40351-1009
Mailing address
PO Box 790
Ashland, KY 41105-0790
Phone (606) 329-8588
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 30608012 | Medicaid | KY |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 103796 | KY | MD | Professional Counselor |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1252022400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1517875200000",
"number": "1114250347",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 790",
"city": "ASHLAND",
"state": "KY",
"postal_code": "411050790",
"telephone_number": "606-329-8588",
"fax_number": "606-329-8195"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "411 BISHOP CT",
"city": "MOREHEAD",
"state": "KY",
"postal_code": "403511009",
"telephone_number": "606-784-2096"
}
],
"practiceLocations": [],
"basic": {
"last_name": "JONES-WALLACE",
"first_name": "TINA",
"middle_name": "MARIE",
"credential": "LPCC",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2009-09-04",
"last_updated": "2018-02-06",
"status": "A"
},
"taxonomies": [
{
"code": "101YP2500X",
"taxonomy_group": "",
"desc": "Counselor, Professional",
"state": "KY",
"license": "103796",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "30608012",
"state": "KY"
}
],
"endpoints": [],
"other_names": []
}Other providers in Morehead, KY
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 6, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.