Active NPI
Ashli Keanan Wallace
- Counselor
- Colorado Springs, CO
National Provider Identifier
1114767837
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Counselor
- License
- AC-1241-33397408
- Practice address
- 2107 Essex LN
Colorado Springs, CO 80909-1425 - Phone
- (808) 778-0777
- NPI assigned
- May 30, 2024
- Sex
- Female
- Sole proprietor
- Yes
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 |
|---|---|---|---|---|
| Counselor | 101Y00000X | AC-1241-33397408 | CO | Primary |
Addresses
Primary practice location
2107 Essex LN
Colorado Springs, CO 80909-1425
Mailing address
2107 Essex LN
Colorado Springs, CO 80909-1425
Phone (808) 778-0777
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 |
|---|---|---|---|
| AC-1241-33397408 | CO | MD | Counselor |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1717027200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1735776000000",
"number": "1114767837",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2107 ESSEX LN",
"city": "COLORADO SPRINGS",
"state": "CO",
"postal_code": "809091425",
"telephone_number": "808-778-0777"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2107 ESSEX LN",
"city": "COLORADO SPRINGS",
"state": "CO",
"postal_code": "809091425",
"telephone_number": "808-778-0777"
}
],
"practiceLocations": [],
"basic": {
"last_name": "WALLACE",
"first_name": "ASHLI",
"middle_name": "KEANAN",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2024-05-30",
"last_updated": "2025-01-02",
"certification_date": "2025-01-02",
"status": "A"
},
"taxonomies": [
{
"code": "101Y00000X",
"taxonomy_group": "",
"desc": "Counselor",
"state": "CO",
"license": "AC-1241-33397408",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Colorado Springs, CO
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 2, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.