Kimberly Devaghun Wallace, MA, LPC, LCDC

Primary specialty

Mental Health CounselorTaxonomy code 101YM0800X

License

92479 Issued in TX

Practice address

1775 Saint James PL Ste 325
Houston, TX 77056-3416

Phone

(713) 730-9783

NPI assigned

Mar 6, 2025

Sex

Female

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

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Credentials

Master of Arts

State licenses

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

{
    "created_epoch": "1741219200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1741219200000",
    "number": "1720886567",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3002 FAIRDALE ESTATES CT",
            "city": "HOUSTON",
            "state": "TX",
            "postal_code": "770572374",
            "telephone_number": "904-860-4443"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1775 SAINT JAMES PL STE 325",
            "city": "HOUSTON",
            "state": "TX",
            "postal_code": "770563416",
            "telephone_number": "713-730-9783"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WALLACE",
        "first_name": "KIMBERLY",
        "middle_name": "DEVAGHUN",
        "credential": "MA, LPC, LCDC",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2025-03-06",
        "last_updated": "2025-03-06",
        "certification_date": "2025-03-06",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YM0800X",
            "taxonomy_group": "",
            "desc": "Counselor, Mental Health",
            "state": "TX",
            "license": "92479",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• James Oran Wallace, M. D.
• Jeannine M Wallace, P.A.-C
• Joanne Wallace, M.A., LPC-S
• John M Wallace, LO
• Kathryn Wakefield Wallace, PA-C
• Lamerika Wallace
• Leroy Wallace II, QMHP-CS
• Lindsey Wallace, APN
• Marcy Marie Wallace, LSSP, PA
• Maria Annette Wallace

• Mental Health Counselor in Houston, TX
• Providers in Houston, TX by specialty
• Mental Health Counselor in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 6, 2025; 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.