Jennifer Dawn Wallace, LPCC/S

Primary specialty

Professional CounselorTaxonomy code 101YP2500X

License

104157

Practice address

204 Bevins LN Ste a
Georgetown, KY 40324-6145

Phone

(859) 951-9777

Fax

(859) 951-9779

NPI assigned

Mar 12, 2020

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

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

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.

• Lesa Young Counseling, LLC

  • Mental Health Counselor
  • Georgetown, KY
  • NPI 1750854170

  Professional

  NPD

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

{
    "created_epoch": "1583971200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1605830400000",
    "number": "1174158976",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "204 BEVINS LN STE A",
            "city": "GEORGETOWN",
            "state": "KY",
            "postal_code": "403246145",
            "telephone_number": "859-951-9777",
            "fax_number": "859-951-9779"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "204 BEVINS LN STE A",
            "city": "GEORGETOWN",
            "state": "KY",
            "postal_code": "403246145",
            "telephone_number": "859-951-9777",
            "fax_number": "859-951-9779"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "200 Bevins Ln Ste E",
            "address_purpose": "LOCATION",
            "city": "Georgetown",
            "state": "KY",
            "postal_code": "403248532",
            "country_code": "US",
            "telephone_number": "859-951-9777",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "WALLACE",
        "first_name": "JENNIFER",
        "middle_name": "DAWN",
        "credential": "LPCC/S",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2020-03-12",
        "last_updated": "2020-11-20",
        "certification_date": "2020-11-20",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YP2500X",
            "taxonomy_group": "",
            "desc": "Counselor, Professional",
            "state": null,
            "license": "104157",
            "primary": true
        },
        {
            "code": "101Y00000X",
            "taxonomy_group": "",
            "desc": "Counselor",
            "state": "KY",
            "license": "104157",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Wal-Mart Stores East LP
• Wal-Mart Stores East, LP
• Walgreen Co
• Lily Abbott Hoover Walker, PA-C
• Sarah Walker
• Robert Lee Walters Jr., RPH
• Wangbuiods PLLC
• Haley Camryn Ward
• Palmer James Ward
• Cindy Gail Warren, M.A. CCC-SLP

• Professional Counselor in Georgetown, KY
• Providers in Georgetown, KY by specialty
• Professional Counselor in Kentucky

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 20, 2020; 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.