Active NPI
Harold Wayne Wallace, LPC
- Mental Health Counselor
- Odessa, TX
National Provider Identifier
1699045302
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Mental Health Counselor
- License
- 10091
- Practice address
- 21 Wallbrook TRL
Odessa, TX 79762-5213 - Phone
- (432) 550-4563
- NPI assigned
- Jan 11, 2012
- Sex
- Male
- 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 |
|---|---|---|---|---|
| Mental Health Counselor | 101YM0800X | 10091 | TX | Primary |
Addresses
Primary practice location
21 Wallbrook TRL
Odessa, TX 79762-5213
Mailing address
21 Wallbrook TRL
Odessa, TX 79762-5213
Phone (432) 550-4563
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
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 10091 | TX | MD | Specialist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1326240000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1326240000000",
"number": "1699045302",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "21 WALLBROOK TRL",
"city": "ODESSA",
"state": "TX",
"postal_code": "797625213",
"telephone_number": "432-550-4563"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "21 WALLBROOK TRL",
"city": "ODESSA",
"state": "TX",
"postal_code": "797625213",
"telephone_number": "432-550-4563"
}
],
"practiceLocations": [],
"basic": {
"last_name": "WALLACE",
"first_name": "HAROLD",
"middle_name": "WAYNE",
"credential": "LPC",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2012-01-11",
"last_updated": "2012-01-11",
"status": "A"
},
"taxonomies": [
{
"code": "101YM0800X",
"taxonomy_group": "",
"desc": "Counselor, Mental Health",
"state": "TX",
"license": "10091",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Odessa, TX
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 11, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.