Marguerite Therese Wallace, MSEA, LPCC-S

Primary specialty

Mental Health CounselorTaxonomy code 101YM0800X

License

0002893 Issued in OH

Practice address

2621 Dryden Rd. the Flexman Myers Clinic
Suite 202
Dayton, OH 45439

Phone

(937) 256-5300

NPI assigned

Sep 7, 2007

Sex

Female

Sole proprietor

Yes

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

Medicare enrollment (NPD)

Not 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 and National Provider Directory roles.

• Flexman Myers Clinic LLC

  • Psychologist
  • Moraine, OH
  • NPI 1457754863
  NPD

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

{
    "created_epoch": "1189123200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1632960000000",
    "number": "1659566164",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2621 DRYDEN RD. THE FLEXMAN MYERS CLINIC",
            "address_2": "SUITE 202",
            "city": "DAYTON",
            "state": "OH",
            "postal_code": "45439",
            "telephone_number": "937-256-5300",
            "fax_number": "937-258-4162"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2621 DRYDEN RD. THE FLEXMAN MYERS CLINIC",
            "address_2": "SUITE 202",
            "city": "DAYTON",
            "state": "OH",
            "postal_code": "45439",
            "telephone_number": "937-256-5300"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WALLACE",
        "first_name": "MARGUERITE",
        "middle_name": "THERESE",
        "credential": "MSEA, LPCC-S",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2007-09-07",
        "last_updated": "2021-09-30",
        "certification_date": "2021-09-30",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YM0800X",
            "taxonomy_group": "",
            "desc": "Counselor, Mental Health",
            "state": "OH",
            "license": "2893",
            "primary": false
        },
        {
            "code": "101YM0800X",
            "taxonomy_group": "",
            "desc": "Counselor, Mental Health",
            "state": "OH",
            "license": "0002893",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Alicia M Wallace
• Alisha Wallace, DPM
• Betty Wallace
• Devyn Wallace
• Erin Michelle Wallace, MSW
• Rhea Wallace
• Tonya Michelle Wallace
• Torrie Wallace
• Traci Wallace L Wallace
• Zachary Waller

• Mental Health Counselor in Dayton, OH
• Providers in Dayton, 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 Sep 30, 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.

Verify at the official NPI Registry.