Jennifer Anne Wallace, LPC

Primary specialty

Professional CounselorTaxonomy code 101YP2500X

License

89792 Issued in TX

Practice address

9503 Oak Springs Dr
Woodway, TX 76712-6401

Phone

(318) 237-8237

NPI assigned

Oct 19, 2022

Last updated

Oct 19, 2022By the provider in NPPES

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 TX

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

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.

• Heart of Texas Community Health Center Inc

  dba Waco Family Medicine - Madison Cooper

  • Federally Qualified Health Center (FQHC)
  • Waco, TX
  • NPI 1568191492
  Medicare reassignment NPD
• Thrive Counseling LLC

  dba Thriveworks

  • Mental Health Counselor
  • Lynchburg, VA
  • NPI 1215181300

  TX

  Medicare reassignment
• Heart of Texas Community Health Center Inc

  dba Waco Family Medicine

  • Federally Qualified Health Center (FQHC)
  • Waco, TX
  • NPI 1386427334
  NPD
• Heart of Texas Community Health Center, Inc.

  • Federally Qualified Health Center (FQHC)
  • Temple, TX
  • NPI 1992685218
  NPD
• McLennan County Medical Education and Research Foundation

  dba Family Health Center

  • Family Medicine Physician
  • Waco, TX
  • NPI 1689651440
  NPD

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

{
    "created_epoch": "1666137600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1666137600000",
    "number": "1942927090",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "9503 OAK SPRINGS DR",
            "city": "WOODWAY",
            "state": "TX",
            "postal_code": "767126401",
            "telephone_number": "318-237-8237"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "9503 OAK SPRINGS DR",
            "city": "WOODWAY",
            "state": "TX",
            "postal_code": "767126401",
            "telephone_number": "318-237-8237"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WALLACE",
        "first_name": "JENNIFER",
        "middle_name": "ANNE",
        "credential": "LPC",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2022-10-19",
        "last_updated": "2022-10-19",
        "certification_date": "2022-10-19",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YP2500X",
            "taxonomy_group": "",
            "desc": "Counselor, Professional",
            "state": "TX",
            "license": "89792",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Waco Ocd Inc (Old Corner Drug Waco)
• Kenneth B Waite, D.O.
• Walgreen Co (Walgreens #09648)
• Walgreens
• Dalton Garrett Walker, PA-C
• Russell Scott Warren, DDS, M.D.
• Mya Breann Washington
• Cortney Weaver
• Taylor N Weaver
• Barbara D Weir, APRN

• Professional Counselor in Woodway, TX
• Providers in Woodway, 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 19, 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.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.