Theodore Edwin Walls, M.A., LMHC, LPC

Primary specialty

Mental Health CounselorTaxonomy code 101YM0800X

License

068.0067951 Issued in VT

Practice address

54 Harris PL Ste 105
Brattleboro, VT 05301-6709

Phone

(802) 451-0314

Fax

(877) 532-0268

NPI assigned

Apr 2, 2007

Last updated

Jun 18, 2022By the provider in NPPES

Sex

Male

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 3

Addresses

Medicare fee-for-service enrollment

Enrolled in MA

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, 1998

Medicare assignment

May accept Medicare assignment

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Credentials

Master of Arts

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Green Mountain Counseling Associates

  • Mental Health Counselor
  • Brattleboro, VT
  • NPI 1992152276
  NPD Authorized official

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

{
    "created_epoch": "1175472000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1655510400000",
    "number": "1881714798",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "228 STEADY LN",
            "city": "ASHFIELD",
            "state": "MA",
            "postal_code": "013309724",
            "telephone_number": "413-345-8745"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "54 HARRIS PL STE 105",
            "city": "BRATTLEBORO",
            "state": "VT",
            "postal_code": "053016709",
            "telephone_number": "802-451-0314",
            "fax_number": "877-532-0268"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WALLS",
        "first_name": "THEODORE",
        "middle_name": "EDWIN",
        "credential": "M.A., LMHC, LPC",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2007-04-02",
        "last_updated": "2022-06-18",
        "certification_date": "2022-06-18",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YM0800X",
            "taxonomy_group": "",
            "desc": "Counselor, Mental Health",
            "state": "MA",
            "license": "8227",
            "primary": false
        },
        {
            "code": "101YM0800X",
            "taxonomy_group": "",
            "desc": "Counselor, Mental Health",
            "state": "VT",
            "license": "068.0067951",
            "primary": true
        },
        {
            "code": "101YP2500X",
            "taxonomy_group": "",
            "desc": "Counselor, Professional",
            "state": "TX",
            "license": "16743",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• VT Center for the Deaf & Hoh (Austine Evaluation Center)
• Walter Wagenknecht, MD
• Walgreen Co (Walgreens #07270)
• Walgreen Co (Walgreens #18418)
• Andrew Alasdair Walker, RPH
• Abigail E Warren, LICSW
• William Fred Warriner, LMHC
• Emma Washburn
• Jason Weakley, C.R.N.A.
• Lindsey M Weaver, APRN

• Mental Health Counselor in Brattleboro, VT
• Providers in Brattleboro, VT by specialty
• Mental Health Counselor in Vermont

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 18, 2022; 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.