Emily Wallen, MA, LPC

Primary specialty

Professional CounselorTaxonomy code 101YP2500X

License

19368 Issued in TX

Practice address

4516 Boat Club Rd Ste 106
Fort Worth, TX 76135-7020

Phone

(817) 238-0106

NPI assigned

Dec 7, 2017

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

Medicare fee-for-service enrollment

Enrolled in CO

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, 2002

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Telehealth

Offers telehealth services

Group practices

Paragon Behavioral Health ConnectionsGroup PAC ID 5991218612, 16 clinicians

Freedomchoice LLCGroup PAC ID 8729326988, 8 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Credentials

Master of Arts

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.

• Freedomchoice LLC

  • Clinical Psychologist
  • Littleton, CO
  • NPI 1336633015
  Medicare reassignment Care Compare group NPD
• Paragon Behavioral Health Connections

  • Mental Health Clinic/Center (Including Community Mental Health Center)
  • Lakewood, CO
  • NPI 1811739782
  Medicare reassignment Care Compare group NPD (past)
• Paragon Behavioral Health Connections

  • Mental Health Clinic/Center (Including Community Mental Health Center)
  • Delta, CO
  • NPI 1619710589
  NPD
• Paragon Behavioral Health Connections

  • Mental Health Clinic/Center (Including Community Mental Health Center)
  • Frisco, CO
  • NPI 1639912504
  NPD
• Freedomchoice LLC

  • Mental Health Counselor
  • Fort Collins, CO
  • NPI 1649155086
  NPD (past)

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

{
    "created_epoch": "1512604800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1512604800000",
    "number": "1801301189",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4516 BOAT CLUB RD STE 106",
            "city": "FORT WORTH",
            "state": "TX",
            "postal_code": "761357020",
            "telephone_number": "817-238-0106"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4516 BOAT CLUB RD STE 106",
            "city": "FORT WORTH",
            "state": "TX",
            "postal_code": "761357020",
            "telephone_number": "817-238-0106"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WALLEN",
        "first_name": "EMILY",
        "credential": "MA, LPC",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2017-12-07",
        "last_updated": "2017-12-07",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YP2500X",
            "taxonomy_group": "",
            "desc": "Counselor, Professional",
            "state": "TX",
            "license": "19368",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Gabriel Wallace
• Paige Marie Wallace
• Rafaella Izar Wallace, ANP
• Rane Perry Wallace, MS, LPC, LCDC, SAP
• Taron M Wallace, M.S., CCC-SLP
• Charles F. Waller, CRNA
• Katelyn D'Ann Walley, PTA
• Christine Wallin, RN
• Michele L Wallis, RN
• Walls Universal Home Health & Hospice Services, Inc.

• Professional Counselor in Fort Worth, TX
• Providers in Fort Worth, TX by specialty
• Professional Counselor in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 7, 2017; 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.