Timothy Wallace Jr., EDD

Primary specialty

Professional CounselorTaxonomy code 101YP2500X

License

E.2504990 Issued in OH

Practice address

580 S High St Ste 220
Columbus, OH 43215-5644

Phone

(614) 625-7183

NPI assigned

Sep 12, 2019

Reactivated

Dec 28, 2022

Sex

Male

Sole proprietor

Yes

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

Enrolled in OH

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

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.

• Grow Healthcare Group PA

  • Mental Health Counselor
  • Miami, FL
  • NPI 1245845932

  OH, Professional

  Medicare reassignment NPD
• Dtac of Ohio LLC

  • Mental Illness Community Based Residential Treatment Facility
  • Columbus, OH
  • NPI 1851096473
  NPD (past)
• Hittle House LLC

  • Mental Illness Community Based Residential Treatment Facility
  • Columbus, OH
  • NPI 1720366511
  NPD (past)
• Open Arms Counseling, LLC

  • Mental Health Clinic/Center (Including Community Mental Health Center)
  • Columbus, OH
  • NPI 1639596224
  NPD (past)

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

{
    "created_epoch": "1568246400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1737504000000",
    "number": "1619527611",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "580 S HIGH ST STE 220",
            "city": "COLUMBUS",
            "state": "OH",
            "postal_code": "432155644",
            "telephone_number": "614-625-7183"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "580 S HIGH ST STE 220",
            "city": "COLUMBUS",
            "state": "OH",
            "postal_code": "432155644",
            "telephone_number": "614-625-7183"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WALLACE",
        "first_name": "TIMOTHY",
        "name_prefix": "Dr.",
        "name_suffix": "Jr.",
        "credential": "EDD",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2019-09-12",
        "last_updated": "2025-01-22",
        "certification_date": "2025-01-22",
        "deactivation_date": "2022-12-21",
        "reactivation_date": "2022-12-28",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YP2500X",
            "taxonomy_group": "",
            "desc": "Counselor, Professional",
            "state": "OH",
            "license": "E.2504990",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Peter Yarkpazuo Wallace
• Scott Christopher Wallace, MD
• Sekeshia Wallace
• Shannon May Wallace, NP
• Tamara Jane Wallace, NP
• Travonti Scott Wallace
• Paul Ntoh Wallang
• Randi Walle
• Mark Allen Wallenbrock, M.D.
• Alexandra Wallenhorst, GC

• Professional Counselor in Columbus, OH
• Providers in Columbus, OH by specialty
• Professional Counselor in Ohio

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 22, 2025; 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.