Jerryd Wallace, LPC

Primary specialty

Professional CounselorTaxonomy code 101YP2500X

License

77418 Issued in TX

Practice address

162 N. Dallas Ave
Van Alstyne, TX 75495-7549

Phone

(469) 667-3515

NPI assigned

Oct 1, 2018

Sex

Male

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

Not listed in the public Medicare enrollment file

Eligible to order & refer

• Part B services: No
• Medical equipment: Yes
• Home health: No
• Power mobility devices: No
• Hospice: No

Green means eligible to order or refer.

Medicare enrollment (NPD)

Enrolled

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.

• Hope for Home Counseling

  • Mental Health Clinic/Center (Including Community Mental Health Center)
  • Van Alstyne, TX
  • NPI 1922583483
  NPD Authorized official
• Texoma Community Center

  • Psychiatry Physician
  • Sherman, TX
  • NPI 1851309462

  Professional

  NPD

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

{
    "created_epoch": "1538352000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1538352000000",
    "number": "1821573387",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 2020",
            "city": "VAN ALSTYNE",
            "state": "TX",
            "postal_code": "754952020",
            "telephone_number": "469-667-3515"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "162 N. DALLAS AVE",
            "city": "VAN ALSTYNE",
            "state": "TX",
            "postal_code": "754957549",
            "telephone_number": "469-667-3515"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WALLACE",
        "first_name": "JERRYD",
        "credential": "LPC",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2018-10-01",
        "last_updated": "2018-10-01",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YP2500X",
            "taxonomy_group": "",
            "desc": "Counselor, Professional",
            "state": "TX",
            "license": "77418",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Van Alstyne Dental PLLC
• Van Alstyne Emergency Center
• Van Alstyne Eye Care PLLC
• Van Alstyne Family Dentistry PLLC
• Van Alstyne Physical Therapy
• Paul A Westmoreland II, MD
• Wildflower Counseling TX, PLLC
• Lindsay Roberts Williams, PT
• Leigh Wood, LPC
• Brittany Lauren Worthy

• Professional Counselor in Van Alstyne, TX
• Providers in Van Alstyne, TX by specialty
• Professional Counselor in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 1, 2018; 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.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.