Lisa Wallace, LPC

Primary specialty

Professional CounselorTaxonomy code 101YP2500X

License

0015978 Issued in CO

Practice address

2769 Iris Ave Ste 107
Boulder, CO 80304-4405

Phone

(970) 368-9185

NPI assigned

Jan 22, 2020

Last updated

Jan 22, 2020By the provider in NPPES

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

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

• Brilliantly Sane Counseling and Coaching LLC

  • Professional Counselor
  • Boulder, CO
  • NPI 1558984005
  NPD Authorized official

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

{
    "created_epoch": "1579651200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1579651200000",
    "number": "1336779925",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1600 BRADLEY CT",
            "city": "BOULDER",
            "state": "CO",
            "postal_code": "803057310",
            "telephone_number": "970-389-3612"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2769 IRIS AVE STE 107",
            "city": "BOULDER",
            "state": "CO",
            "postal_code": "803044405",
            "telephone_number": "970-368-9185"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WALLACE",
        "first_name": "LISA",
        "credential": "LPC",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2020-01-22",
        "last_updated": "2020-01-22",
        "certification_date": "2020-01-22",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YP2500X",
            "taxonomy_group": "",
            "desc": "Counselor, Professional",
            "state": "CO",
            "license": "0015978",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "CAQH",
            "identifier": "14607457",
            "state": "CO"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Richard Wall, B.A.
• Hilary Wallace, M.D.
• Jennifer A Wallace, M.A., L.P.C.
• Jessica Wallace
• Julie Lyn Wallace, LPCC
• Mary Louise Wallace, MA, CCC-SLP
• Tereasa Anne Wallace, RN, MN
• Cathrine Skogheim Walle, D.C., B.S.
• Katherine Eleanor Waller
• Lauren Alexandra Waller, LCSW

• Professional Counselor in Boulder, CO
• Providers in Boulder, CO by specialty
• Professional Counselor in Colorado

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 22, 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.