Kristin K Wallace, LMHC

Primary specialty

Mental Health CounselorTaxonomy code 101YM0800X

License

IMH7107 Issued in FL

Practice address

1250 W Eau Gallie Blvd Ste a
Melbourne, FL 32935-5385

Phone

(772) 361-1413

NPI assigned

Jan 20, 2011

Last updated

Jan 9, 2025By the provider in NPPES

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Other names 1

• Kristen Kirby Former name

Medicare fee-for-service enrollment

Enrolled in FL

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, 2016

Medicare assignment

May accept Medicare assignment

Practice addresses (Care Compare)

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, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Complete Family Consultants

  • Mental Health Counselor
  • Melbourne, FL
  • NPI 1730893959
  Medicare reassignment NPD

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

{
    "created_epoch": "1295481600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1736380800000",
    "number": "1922303007",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1250 W EAU GALLIE BLVD STE A",
            "city": "MELBOURNE",
            "state": "FL",
            "postal_code": "329355385",
            "telephone_number": "772-361-1413"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1250 W EAU GALLIE BLVD STE A",
            "city": "MELBOURNE",
            "state": "FL",
            "postal_code": "329355385",
            "telephone_number": "772-361-1413"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "4256 Four Lakes Dr",
            "address_purpose": "LOCATION",
            "city": "Melbourne",
            "state": "FL",
            "postal_code": "329401222",
            "country_code": "US",
            "telephone_number": "321-795-7701",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "WALLACE",
        "first_name": "KRISTIN",
        "middle_name": "K",
        "credential": "LMHC",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2011-01-20",
        "last_updated": "2025-01-09",
        "certification_date": "2025-01-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YM0800X",
            "taxonomy_group": "",
            "desc": "Counselor, Mental Health",
            "state": "FL",
            "license": "IMH7107",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "KRISTEN",
            "last_name": "KIRBY",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Kimberly Walker
• Natacha Walker
• Sherry Walker
• Amanda Wallace
• Kevin H Wallace, MD
• Denise Walleck
• Chrystal A Walls, MSN, FNP
• Robert E. Walsh, PA-C
• Ira M Walter, MSN-ED, APRN, FNP
• Etta Louise Walters, MA

• Mental Health Counselor in Melbourne, FL
• Providers in Melbourne, FL by specialty
• Mental Health Counselor in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 9, 2025; 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.