Holly Wallace, LMHC

Primary specialty

Mental Health CounselorTaxonomy code 101YM0800X

License

MH9182 Issued in FL

Practice address

1968 Sebring Pkwy
Sebring, FL 33870-1654

Phone

(863) 519-0575

Fax

(863) 582-9251

NPI assigned

Apr 9, 2008

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in FL

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

Specialty

Mental Health Counselor

Education

Other, 2004

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Telehealth

Offers telehealth services

Group practices

Peace River Center for Personal Development IncGroup PAC ID 7719877927, 29 clinicians

Practice addresses (Care Compare)

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.

• Peace River Center for Personal Development Inc

  • Mental Health Clinic/Center (Including Community Mental Health Center)
  • Bartow, FL
  • NPI 1821097767
  Medicare reassignment Care Compare group NPD
• Peace River Center for Personal Development Inc

  • Psychiatry Physician
  • Wauchula, FL
  • NPI 1184370504
  NPD (past)
• Peace River Center for Personal Development Inc

  • Mental Health Clinic/Center (Including Community Mental Health Center)
  • Lakeland, FL
  • NPI 1538802939
  NPD (past)

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

{
    "created_epoch": "1207699200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1446076800000",
    "number": "1699948844",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 1559",
            "city": "BARTOW",
            "state": "FL",
            "postal_code": "338311559",
            "telephone_number": "863-519-0575"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1968 SEBRING PKWY",
            "city": "SEBRING",
            "state": "FL",
            "postal_code": "338701654",
            "telephone_number": "863-519-0575",
            "fax_number": "863-582-9251"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WALLACE",
        "first_name": "HOLLY",
        "credential": "LMHC",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2008-04-09",
        "last_updated": "2015-10-29",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YM0800X",
            "taxonomy_group": "",
            "desc": "Counselor, Mental Health",
            "state": "FL",
            "license": "MH9182",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "002054100",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Walgreen Co
• Walgreen Co
• Brandy Leigh Walker
• Janet T. Walker, LMT
• Kylla Wall
• Tabitha Lacie Wallace, M.S., CCC-SLP
• Conrad Walters, PHARMD
• Johnnie Lynette Walters
• Tracy E Walters, DDS
• Charles H Waltman, PA-C

• Mental Health Counselor in Sebring, FL
• Providers in Sebring, FL by specialty
• Mental Health Counselor in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 29, 2015; 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.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.