Leah Jo Wallace, LPC

Primary specialty

Professional CounselorTaxonomy code 101YP2500X

Practice address

915 Highway 84 W
Caruthersville, MO 63830-8113

Phone

(573) 333-5975

NPI assigned

Aug 12, 2021

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in MO

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

Specialty

Mental Health Counselor

Education

Other, 2021

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Family Counseling Center Inc 39 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

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.

• Family Counseling Center, Inc.

  • Community/Behavioral Health Agency
  • Kennett, MO
  • NPI 1669477550

  MO

  Medicare reassignment Care Compare group NPD
• Family Counseling Center, Inc.

  • Primary Care Clinic/Center
  • Poplar Bluff, MO
  • NPI 1235738493
  NPD

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

{
    "created_epoch": "1628726400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1697414400000",
    "number": "1235804121",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "935 STATE ROUTE VV",
            "city": "KENNETT",
            "state": "MO",
            "postal_code": "638573822",
            "telephone_number": "573-888-5925"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "915 HIGHWAY 84 W",
            "city": "CARUTHERSVILLE",
            "state": "MO",
            "postal_code": "638308113",
            "telephone_number": "573-333-5975"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "935 State Route Vv",
            "address_purpose": "LOCATION",
            "city": "Kennett",
            "state": "MO",
            "postal_code": "638573822",
            "country_code": "US",
            "telephone_number": "573-888-5925",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "WALLACE",
        "first_name": "LEAH",
        "middle_name": "JO",
        "credential": "LPC",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2021-08-12",
        "last_updated": "2023-10-16",
        "certification_date": "2023-10-16",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YP2500X",
            "taxonomy_group": "",
            "desc": "Counselor, Professional",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Korissa Taylor
• Jessica Denise Thompson
• Trowbridge Enterprises, LLC Dba Always First in-Home Services
• Jasmin Brianna Walker
• Lavita Walker
• Melissa Ann Watkins, FNP-C
• White & Associates Consumer Directed Services, LLC
• White & Associates Home Assistance, Inc
• White & Associates Home Assistance, Inc.
• Amanda White

• All providers in Caruthersville, MO
• Professional Counselor in Missouri

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 16, 2023; 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.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.