Nichelle M. Wall, M. ED., LPC, CST-C

Primary specialty

Professional CounselorTaxonomy code 101YP2500X

License

69796 Issued in TX

Practice address

1264 Harwood Rd
175
Bedford, TX 76021-4267

Phone

(214) 396-6503

Fax

(469) 359-6729

NPI assigned

May 1, 2014

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

Other identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Eligible to order & refer

• Part B services: No
• Medical equipment: Yes
• Home health: No
• Power mobility devices: No
• Hospice: No

Green means eligible to order or refer.

Medicare enrollment (NPD)

Enrolled

Credentials

Master of Education

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 and National Provider Directory roles.

• Balance Beacon

  • Professional Counselor
  • Euless, TX
  • NPI 1942661327
  NPD (past)
• Balance Beacon Massage & Bodywork

  • Massage Therapist
  • Euless, TX
  • NPI 1427805803
  NPD (past)

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

{
    "created_epoch": "1398902400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1458086400000",
    "number": "1437569324",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1169 N BURLESON BLVD",
            "address_2": "107 PMB 242",
            "city": "BURLESON",
            "state": "TX",
            "postal_code": "760287011",
            "telephone_number": "214-396-6503",
            "fax_number": "469-359-6729"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1264 HARWOOD RD",
            "address_2": "175",
            "city": "BEDFORD",
            "state": "TX",
            "postal_code": "760214267",
            "telephone_number": "214-396-6503",
            "fax_number": "469-359-6729"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WALL",
        "first_name": "NICHELLE",
        "middle_name": "M.",
        "credential": "M. ED., LPC, CST-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2014-05-01",
        "last_updated": "2016-03-16",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YP2500X",
            "taxonomy_group": "",
            "desc": "Counselor, Professional",
            "state": "TX",
            "license": "69796",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "220346501",
            "state": "TX"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Walgreen Co
• Walgreen Co
• Usha Walia, M.D
• Joel Wayne Walker, M.D.
• Ulizabeth Monique Walker, LPC
• Ansley Waller, MSN, APRN, AGACNP-BC
• Sharon Walters, RN, CNS, PMHNP
• Terry Lynne Walters, PH.D.
• Lindsey Nicole Wamsley, MA, LPC
• Jackie Diem Wang, O.D.

• Professional Counselor in Bedford, TX
• Providers in Bedford, TX by specialty
• Professional Counselor in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 16, 2016; 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.