Nicole Broadway Wallace, LPCC

Primary specialty

Professional CounselorTaxonomy code 101YP2500X

License

9626 Issued in CA

Practice address

207 Belo Dr
Killeen, TX 76542-5598

Phone

(254) 630-7450

Fax

(254) 853-4241

NPI assigned

Mar 8, 2010

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

Other names 1

• Nicole Jane Broadway Former name

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

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

{
    "created_epoch": "1268006400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1750636800000",
    "number": "1821311606",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2201 S. WS YOUNG DR",
            "address_2": "SUITE 106-C OFFICE 105",
            "city": "KILLEEN",
            "state": "TX",
            "postal_code": "76543",
            "telephone_number": "254-630-7450",
            "fax_number": "254-853-4241"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "207 BELO DR",
            "city": "KILLEEN",
            "state": "TX",
            "postal_code": "765425598",
            "telephone_number": "254-630-7450",
            "fax_number": "254-853-4241"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WALLACE",
        "first_name": "NICOLE",
        "middle_name": "BROADWAY",
        "credential": "LPCC",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2010-03-08",
        "last_updated": "2025-06-23",
        "certification_date": "2025-06-23",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YP2500X",
            "taxonomy_group": "",
            "desc": "Counselor, Professional",
            "state": "TX",
            "license": "19501",
            "primary": false
        },
        {
            "code": "101YP2500X",
            "taxonomy_group": "",
            "desc": "Counselor, Professional",
            "state": "CA",
            "license": "9626",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "NICOLE",
            "last_name": "BROADWAY",
            "middle_name": "JANE",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Kenyetta Lafrancis Walker, LPC, LCDC
• Kyesha Walker
• Chazia Wall-Miles, LPC
• Wallace Speech Therapy
• James Wallace, HIS
• Cynthia Waller, ED.S, CCC-SLP
• Cheyenne Walling
• Mark Edward Walls Jr., LCDC
• Walnut Grove Community Services
• Walnut Grove Community Services, Inc.

• Professional Counselor in Killeen, TX
• Providers in Killeen, TX by specialty
• Professional Counselor in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 23, 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.