Karen Marie Wallis, M.ED., PCC, LCDC III

Primary specialty

Mental Health CounselorTaxonomy code 101YM0800X

License

E. 0500432 Issued in OH

Practice address

29325 Chagrin Blvd
Suite #102
Beachwood, OH 44122-4600

Phone

(216) 548-0523

NPI assigned

Nov 7, 2009

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

Opted out of Medicare

Yes, effective Jan 17, 2024 through Jan 17, 2028

Medicare enrollment (NPD)

Not enrolled

Credentials

Master of Education

State licenses

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

{
    "created_epoch": "1257552000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1257552000000",
    "number": "1730416017",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 158",
            "city": "RICHFIELD",
            "state": "OH",
            "postal_code": "442860158",
            "telephone_number": "216-548-0523"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "29325 CHAGRIN BLVD",
            "address_2": "SUITE #102",
            "city": "BEACHWOOD",
            "state": "OH",
            "postal_code": "441224600",
            "telephone_number": "216-548-0523"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WALLIS",
        "first_name": "KAREN",
        "middle_name": "MARIE",
        "credential": "M.ED., PCC, LCDC III",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2009-11-07",
        "last_updated": "2009-11-07",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YA0400X",
            "taxonomy_group": "",
            "desc": "Counselor, Addiction (Substance Use Disorder)",
            "state": "OH",
            "license": "091014",
            "primary": false
        },
        {
            "code": "101YM0800X",
            "taxonomy_group": "",
            "desc": "Counselor, Mental Health",
            "state": "OH",
            "license": "E. 0500432",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Jennifer S Walinsky, PH.D.
• Erin Walker, CDCA
• Nefertiti Walker
• Frankie Elizabeth Waller, PA-C
• Mary Elizabeth Waller, PHD
• Abbigail Walls
• Malcolm Walters
• Waltman Psychological Services LLC
• Loretta A Walton, LPC
• Shannon A Walton, PHARMD, MBA

• Mental Health Counselor in Beachwood, OH
• Providers in Beachwood, 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 Nov 7, 2009; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Opt Out Affidavits.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.