Active NPI
Vickie Renee Keeling-Wallace, M.A.
- Professional Counselor
- Columbia, MO
National Provider Identifier
1477887826
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Professional Counselor
- License
- 000891
- Practice address
- 3407 Berrywood Dr
Suite 200
Columbia, MO 65201-6500 - Phone
- (573) 443-1177
- NPI assigned
- Oct 1, 2009
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Professional Counselor | 101YP2500X | 000891 | MO | Primary |
Addresses
Primary practice location
3407 Berrywood Dr
Suite 200
Columbia, MO 65201-6500
Mailing address
213 Bittersweet CT.
Columbia, MO 65203
Phone (573) 823-3878
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
- Credentials
- Master of Arts
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 000891 | MO | MD | Professional Counselor |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1254355200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1254355200000",
"number": "1477887826",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "213 BITTERSWEET CT.",
"city": "COLUMBIA",
"state": "MO",
"postal_code": "65203",
"telephone_number": "573-823-3878"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "3407 BERRYWOOD DR",
"address_2": "SUITE 200",
"city": "COLUMBIA",
"state": "MO",
"postal_code": "652016500",
"telephone_number": "573-443-1177"
}
],
"practiceLocations": [],
"basic": {
"last_name": "KEELING-WALLACE",
"first_name": "VICKIE",
"middle_name": "RENEE",
"name_prefix": "Ms.",
"credential": "M.A.",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2009-10-01",
"last_updated": "2009-10-01",
"status": "A"
},
"taxonomies": [
{
"code": "101YP2500X",
"taxonomy_group": "",
"desc": "Counselor, Professional",
"state": "MO",
"license": "000891",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Columbia, MO
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 1, 2009; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.