Lisa Wallace

Primary specialty

Mental Health CounselorTaxonomy code 101YM0800X

License

180.008731 Issued in IL

Legal business name

LISA WALLACE

Practice address

20200 Governors Dr
107
Olympia Fields, IL 60461-1032

Phone

(708) 462-4235

NPI assigned

Jun 27, 2014

Organization subpart

No

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

Authorized official

Name

Lisa Wallace, LCPC

Title

Provider

Phone

(708) 906-0205

Specialties & licenses 6

Addresses

Locations

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Lisa Walker, LCPC

  • Mental Health Counselor
  • Olympia Fields, IL
  • NPI 1619300605

  Addiction (Substance Use Disorder)

  NPD (past)

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

{
    "created_epoch": "1403827200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1403827200000",
    "number": "1427463405",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1835 W 34TH ST",
            "city": "STEGER",
            "state": "IL",
            "postal_code": "604751499",
            "telephone_number": "708-906-0205"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "20200 GOVERNORS DR",
            "address_2": "107",
            "city": "OLYMPIA FIELDS",
            "state": "IL",
            "postal_code": "604611032",
            "telephone_number": "708-462-4235"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LISA WALLACE",
        "organizational_subpart": "NO",
        "enumeration_date": "2014-06-27",
        "last_updated": "2014-06-27",
        "status": "A",
        "authorized_official_last_name": "WALLACE",
        "authorized_official_first_name": "LISA",
        "authorized_official_title_or_position": "PROVIDER",
        "authorized_official_telephone_number": "708-906-0205",
        "authorized_official_credential": "LCPC"
    },
    "taxonomies": [
        {
            "code": "101Y00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Counselor",
            "state": "IL",
            "license": "180.008731",
            "primary": false
        },
        {
            "code": "101YA0400X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Counselor, Addiction (Substance Use Disorder)",
            "state": "IL",
            "license": "180.008731",
            "primary": false
        },
        {
            "code": "101YM0800X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Counselor, Mental Health",
            "state": "IL",
            "license": "180.008731",
            "primary": true
        },
        {
            "code": "101YP1600X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Counselor, Pastoral",
            "state": "IL",
            "license": "180.008731",
            "primary": false
        },
        {
            "code": "101YP2500X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Counselor, Professional",
            "state": "IL",
            "license": "180.008731",
            "primary": false
        },
        {
            "code": "106H00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Marriage & Family Therapist",
            "state": "IL",
            "license": "180.008731",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Letasha Lewis, MSN, FNP-C
• Justin Li, DO
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• Easter Lilly
• Louis L Lipschultz, OD
• Llcdental,
• Karlos Lloyd
• Flavion Lockett, CSFA
• Robert Alan Look Jr.
• Aman Luthra, MD

• Mental Health Counselor in Olympia Fields, IL
• Providers in Olympia Fields, IL by specialty
• Mental Health Counselor in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 27, 2014; 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.