Lisa M Wallace, MA, LPC

Primary specialty

Professional CounselorTaxonomy code 101YP2500X

License

5913 Issued in CO

Practice address

4103 E Boardwalk Drive
Suite 202
Fort Collins, CO 80525-5930

Phone

(970) 817-4049

Fax

(877) 833-4460

NPI assigned

Nov 30, 2005

Sex

Female

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in CO

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: No
• Power mobility devices: No
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

Credentials

Master of Arts

State licenses

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Wallace Counseling, LLC

  • Professional Counselor
  • Fort Collins, CO
  • NPI 1396028544
  Medicare reassignment NPD Authorized official
• Wallace Counseling, LLC

  • Professional Counselor
  • Fort Collins, CO
  • NPI 1003271297
  NPD Authorized official

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

{
    "created_epoch": "1133308800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1764547200000",
    "number": "1124002571",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 273338",
            "city": "FORT COLLINS",
            "state": "CO",
            "postal_code": "805273338",
            "telephone_number": "970-817-4049",
            "fax_number": "877-833-4460"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4103 E BOARDWALK DRIVE",
            "address_2": "SUITE 202",
            "city": "FORT COLLINS",
            "state": "CO",
            "postal_code": "805255930",
            "telephone_number": "970-817-4049",
            "fax_number": "877-833-4460"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WALLACE",
        "first_name": "LISA",
        "middle_name": "M",
        "credential": "MA, LPC",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2005-11-30",
        "last_updated": "2025-12-01",
        "certification_date": "2025-12-01",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YP2500X",
            "taxonomy_group": "",
            "desc": "Counselor, Professional",
            "state": "WY",
            "license": "906",
            "primary": false
        },
        {
            "code": "101YP2500X",
            "taxonomy_group": "",
            "desc": "Counselor, Professional",
            "state": "CO",
            "license": "5913",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BS OF WY",
            "identifier": "312410",
            "state": "WY"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Milena Walkowiak, LPC, NCC
• Nikodem Walkowiak
• Wallace Counseling, LLC
• Wallace Counseling, LLC
• Anne Wallace, MD
• Susan Wallace, LPN
• Kathlene Sue Waller, M.D.
• Kristin Wallick, M.D.
• Daniel Wallis, DC
• Jacque Wallis, RN

• Professional Counselor in Fort Collins, CO
• Providers in Fort Collins, CO by specialty
• Professional Counselor in Colorado

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 1, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.