Active NPI
Elizabeth Frances Wallace, MA, LPC
- Professional Counselor
- Portland, OR
National Provider Identifier
1659538189
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Professional Counselor
- License
- C2083
- Practice address
- 6360 SW Merlin CT
Portland, OR 97219-4942 - Phone
- (503) 317-2498
- NPI assigned
- May 21, 2008
- Sex
- Female
- Sole proprietor
- Yes
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 | C2083 | OR | Primary |
Addresses
Primary practice location
6360 SW Merlin CT
Portland, OR 97219-4942
Mailing address
6360 SW Merlin CT
Portland, OR 97219-4942
Phone (503) 317-2498
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 164936 | Medicaid | OR |
Other names 1
- Miss Elizabeth Frances Jacob
Electronic endpoints 1
| Type | Endpoint | Use | Affiliation |
|---|---|---|---|
| Other URL | liz@lizwallacetherapy.com | Direct |
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 |
|---|---|---|---|
| C2083 | OR | MD | Professional Counselor |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1211328000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1638576000000",
"number": "1659538189",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "6360 SW MERLIN CT",
"city": "PORTLAND",
"state": "OR",
"postal_code": "972194942",
"telephone_number": "503-317-2498"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "6360 SW MERLIN CT",
"city": "PORTLAND",
"state": "OR",
"postal_code": "972194942",
"telephone_number": "503-317-2498"
}
],
"practiceLocations": [],
"basic": {
"last_name": "WALLACE",
"first_name": "ELIZABETH",
"middle_name": "FRANCES",
"name_prefix": "Mrs.",
"credential": "MA, LPC",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2008-05-21",
"last_updated": "2021-12-04",
"certification_date": "2021-12-04",
"status": "A"
},
"taxonomies": [
{
"code": "101YP2500X",
"taxonomy_group": "",
"desc": "Counselor, Professional",
"state": "OR",
"license": "C2083",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "164936",
"state": "OR"
}
],
"endpoints": [
{
"endpointType": "OTHERS",
"endpointTypeDescription": "Other URL",
"endpoint": "liz@lizwallacetherapy.com",
"affiliation": "N",
"endpointDescription": "gmail",
"use": "DIRECT",
"useDescription": "Direct",
"address_1": "6360 SW Merlin Ct",
"city": "Portland",
"state": "OR",
"country_code": "US",
"postal_code": "972194942",
"country_name": "United States",
"address_type": "DOM"
}
],
"other_names": [
{
"first_name": "ELIZABETH",
"last_name": "JACOB",
"middle_name": "FRANCES",
"prefix": "MISS",
"code": "1",
"type": "Former Name"
}
]
}Other providers in Portland, OR
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 4, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.