Alex Wallace, MA, LMHC, LPCC

Primary specialty

Mental Health CounselorTaxonomy code 101YM0800X

License

E.2102199 Issued in OH

Practice address

6675 Wesselman Road
Cincinnati, OH 45248

Phone

(513) 407-8788

Fax

(513) 417-8955

NPI assigned

Aug 1, 2018

Sex

Male

Sole proprietor

No

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

Specialties & licenses 2

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.

Opted out of Medicare

Yes, effective Jun 7, 2024 through Jun 7, 2028

Medicare enrollment (NPD)

Not enrolled

Credentials

Master of Arts

State licenses

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

{
    "created_epoch": "1533081600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1728432000000",
    "number": "1437637592",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6675 WESSELMAN ROAD",
            "city": "CINCINNATI",
            "state": "OH",
            "postal_code": "45248",
            "telephone_number": "513-407-8788",
            "fax_number": "513-417-8955"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6675 WESSELMAN ROAD",
            "city": "CINCINNATI",
            "state": "OH",
            "postal_code": "45248",
            "telephone_number": "513-407-8788",
            "fax_number": "513-417-8955"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WALLACE",
        "first_name": "ALEX",
        "credential": "MA, LMHC, LPCC",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2018-08-01",
        "last_updated": "2024-10-09",
        "certification_date": "2024-10-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YM0800X",
            "taxonomy_group": "",
            "desc": "Counselor, Mental Health",
            "state": "IN",
            "license": "39003606A",
            "primary": false
        },
        {
            "code": "101YM0800X",
            "taxonomy_group": "",
            "desc": "Counselor, Mental Health",
            "state": "OH",
            "license": "E.2102199",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Quinton Wall
• Sheila Wall, MD
• Shelby Wall
• Wallace Family Dentistry LLC
• Wallace Physician Services LLC
• Alexandria Wallace
• Allison Wallace, MSW, MFT
• Anne M. Wallace, PH.D.
• Brandon Tobias Wallace, DMD
• Chasei Wallace

• Mental Health Counselor in Cincinnati, OH
• Providers in Cincinnati, OH by specialty
• Mental Health Counselor in Ohio

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 9, 2024; 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; Opt Out Affidavits.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.