Anne Marie Wallace, LPC

Primary specialty

Professional CounselorTaxonomy code 101YP2500X

License

6914 Issued in LA

Practice address

1505 N Florida St
Covington, LA 70433-1544

Phone

(985) 900-1626

NPI assigned

Dec 23, 2020

Last updated

Dec 23, 2020By the provider in NPPES

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Electronic endpoints 1

Medicare fee-for-service enrollment

Enrolled in LA

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.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

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, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Start Corporation

  • Mental Health Clinic/Center (Including Community Mental Health Center)
  • Houma, LA
  • NPI 1700156866
  Medicare reassignment NPD
• Start Corporation

  dba Start Community Health Center

  • Federally Qualified Health Center (FQHC)
  • Mandeville, LA
  • NPI 1346712957
  NPD

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

{
    "created_epoch": "1608681600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1608681600000",
    "number": "1508453655",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "21226 CASRIL DR",
            "city": "MANDEVILLE",
            "state": "LA",
            "postal_code": "704717614",
            "telephone_number": "504-491-0210"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1505 N FLORIDA ST",
            "city": "COVINGTON",
            "state": "LA",
            "postal_code": "704331544",
            "telephone_number": "985-900-1626"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WALLACE",
        "first_name": "ANNE",
        "middle_name": "MARIE",
        "name_prefix": "Mrs.",
        "credential": "LPC",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2020-12-23",
        "last_updated": "2020-12-23",
        "certification_date": "2020-12-23",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YP2500X",
            "taxonomy_group": "",
            "desc": "Counselor, Professional",
            "state": "LA",
            "license": "6914",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "OTHERS",
            "endpointTypeDescription": "Other URL",
            "endpoint": "Start",
            "affiliation": "N",
            "address_1": "1505 N Florida St",
            "city": "Covington",
            "state": "LA",
            "country_code": "US",
            "postal_code": "704331544",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

• Walgreen Co (Walgreens #09990)
• Walgreen Co (Walgreens #09645)
• Walk With Me Community Improvement Center
• Jennifer Walkenford, LAC-CCS, NCC
• Kassidy B Wall, FNP
• Huong Tran Wallace, FNP-C
• Kirsten N Wallace, N/A
• Marquita Diane Wallace
• Joshua K Walls, MD
• Michael E Walsh, MD

• Professional Counselor in Covington, LA
• Providers in Covington, LA by specialty
• Professional Counselor in Louisiana

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 23, 2020; 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.