Wallace Place in the Pines

Primary specialty

Mental Illness Community Based Residential Treatment FacilityTaxonomy code 320800000X

Legal business name

WALLACE PLACE IN THE PINES

Practice address

1706 Davis Ave
Livingston, TX 77351-2004

Phone

(936) 223-4542

NPI assigned

May 23, 2019

Organization subpart

No

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

Authorized official

Name

Barbara Ann Wallace

Title

Owner

Phone

(936) 662-5617

Specialties & licenses 6

Addresses

Other names 1

• Wallace Place In The Pines Former legal business name

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

{
    "created_epoch": "1558569600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1559606400000",
    "number": "1194382374",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1706 DAVIS AVE",
            "city": "LIVINGSTON",
            "state": "TX",
            "postal_code": "773512004",
            "telephone_number": "936-223-4542"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1706 DAVIS AVE",
            "city": "LIVINGSTON",
            "state": "TX",
            "postal_code": "773512004",
            "telephone_number": "936-223-4542"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "WALLACE PLACE IN THE PINES",
        "organizational_subpart": "NO",
        "enumeration_date": "2019-05-23",
        "last_updated": "2019-06-04",
        "status": "A",
        "authorized_official_last_name": "WALLACE",
        "authorized_official_first_name": "BARBARA",
        "authorized_official_middle_name": "ANN",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "936-662-5617"
    },
    "taxonomies": [
        {
            "code": "102X00000X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Poetry Therapist",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "320800000X",
            "taxonomy_group": "",
            "desc": "Community Based Residential Treatment Facility, Mental Illness",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "320900000X",
            "taxonomy_group": "",
            "desc": "Community Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "322D00000X",
            "taxonomy_group": "",
            "desc": "Residential Treatment Facility, Emotionally Disturbed Children",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "323P00000X",
            "taxonomy_group": "",
            "desc": "Psychiatric Residential Treatment Facility",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "385HR2060X",
            "taxonomy_group": "",
            "desc": "Respite Care, Respite Care, Intellectual and/or Developmental Disabilities, Child",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Wallace Place In The Pines",
            "code": "4",
            "type": "Former Legal Business Name"
        },
        {
            "organization_name": "Wallace Place In The Pines",
            "code": "4",
            "type": "Former Legal Business Name"
        }
    ]
}

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• William Allan Wall, D.C.
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• Jennifer Laird Wallace, LPC
• Helen Wallington
• Walson, Inc,
• Beth-Michele Wargo, RN., CNM
• William E. Watson, O.D.

• Mental Illness Community Based Residential Treatment Facility in Livingston, TX
• Providers in Livingston, TX by specialty
• Mental Illness Community Based Residential Treatment Facility in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 4, 2019; 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.