Jessica Marie Wallace, MA, LMHCA, NCC

Primary specialty

Mental Health CounselorTaxonomy code 101YM0800X

License

LH61280794 Issued in WA

Practice address

750 George Washington Way Ste 8
Richland, WA 99352-4247

Phone

(509) 676-6735

NPI assigned

Aug 16, 2019

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

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Credentials

Master of Arts

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.

• Renew Counseling Services LLC

  • Mental Health Counselor
  • Richland, WA
  • NPI 1841846664
  NPD Authorized official

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

{
    "created_epoch": "1565913600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1665619200000",
    "number": "1427604248",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "750 GEORGE WASHINGTON WAY STE 8",
            "city": "RICHLAND",
            "state": "WA",
            "postal_code": "993524247",
            "telephone_number": "509-676-6735"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "750 GEORGE WASHINGTON WAY STE 8",
            "city": "RICHLAND",
            "state": "WA",
            "postal_code": "993524247",
            "telephone_number": "509-676-6735"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WALLACE",
        "first_name": "JESSICA",
        "middle_name": "MARIE",
        "credential": "MA, LMHCA, NCC",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2019-08-16",
        "last_updated": "2022-10-13",
        "certification_date": "2022-10-13",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YM0800X",
            "taxonomy_group": "",
            "desc": "Counselor, Mental Health",
            "state": "WA",
            "license": "LH61280794",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• John C Walker, M.D.
• Katelyn Walker
• Lori Walker, MA, LMFT
• Walla Walla Vamc
• Cynthia Wallace, LMHC
• Steven Lane Wallace
• Benjamin Walling
• Walmart Inc.
• Carrie A Walters, PHARM.D
• Delphine Wang, PHARM D

• Mental Health Counselor in Richland, WA
• Providers in Richland, WA by specialty
• Mental Health Counselor in Washington

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 13, 2022; 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.