Joey Lynn Wallace

Primary specialty

Mental Health CounselorTaxonomy code 101YM0800X

License

25576 Issued in MD

Practice address

14 S Broadway
Baltimore, MD 21231-1712

Phone

(410) 276-1773

NPI assigned

Nov 26, 2019

Sex

Male

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

Not listed in the public Medicare enrollment file

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.

Medicare enrollment (NPD)

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.

• Powell Recovery Center, Inc.

  • Adult Mental Health Clinic/Center
  • Baltimore, MD
  • NPI 1699928994
  NPD

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

{
    "created_epoch": "1574726400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1574726400000",
    "number": "1255977138",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "14 S BROADWAY",
            "city": "BALTIMORE",
            "state": "MD",
            "postal_code": "212311712",
            "telephone_number": "410-276-1773"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "14 S BROADWAY",
            "city": "BALTIMORE",
            "state": "MD",
            "postal_code": "212311712",
            "telephone_number": "410-276-1773"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WALLACE",
        "first_name": "JOEY",
        "middle_name": "LYNN",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2019-11-26",
        "last_updated": "2019-11-26",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YM0800X",
            "taxonomy_group": "",
            "desc": "Counselor, Mental Health",
            "state": "MD",
            "license": "25576",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Darrell Dewayne Wallace Jr., LGPC
• Darryl John Wallace, CSC-AD
• Desiree Wallace
• Edward Anthony Wallace
• Jerrol B Wallace, CRNA
• Lula Wallace, CAC-AD
• Matthew Tristan Wallace, M.D.
• Nancy Wallace, PHD
• Patrick William Wallace, PT
• Rachael Wallace, LCSW

• Mental Health Counselor in Baltimore, MD
• Providers in Baltimore, MD by specialty
• Mental Health Counselor in Maryland

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 26, 2019; 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.