Active NPI
Wallace E Paker, LPC
- Professional Counselor
- Lufkin, TX
National Provider Identifier
1972621464
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Professional Counselor
- License
- 62760
- Practice address
- 4101 S Medford Dr
Lufkin, TX 75901-5633 - Phone
- (936) 633-5676
- Fax
- (936) 633-5695
- NPI assigned
- Mar 26, 2007
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Professional Counselor | 101YP2500X | 62760 | TX | Primary |
Addresses
Primary practice location
4101 S Medford Dr
Lufkin, TX 75901-5633
Mailing address
4101 S Medford Dr
Lufkin, TX 75901-5633
Phone (936) 633-5676
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 85275L | Other | TX | BLUE CROSS BLUE SHEILD |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 62760 | TX | MD | Pharmacotherapy Pharmacist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1174867200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1204588800000",
"number": "1972621464",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "4101 S MEDFORD DR",
"city": "LUFKIN",
"state": "TX",
"postal_code": "759015633",
"telephone_number": "936-633-5676",
"fax_number": "936-633-5695"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "4101 S MEDFORD DR",
"city": "LUFKIN",
"state": "TX",
"postal_code": "759015633",
"telephone_number": "936-633-5676",
"fax_number": "936-633-5695"
}
],
"practiceLocations": [],
"basic": {
"last_name": "PAKER",
"first_name": "WALLACE",
"middle_name": "E",
"credential": "LPC",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2007-03-26",
"last_updated": "2008-03-04",
"status": "A"
},
"taxonomies": [
{
"code": "101YP2500X",
"taxonomy_group": "",
"desc": "Counselor, Professional",
"state": "TX",
"license": "62760",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BLUE CROSS BLUE SHEILD",
"identifier": "85275L",
"state": "TX"
}
],
"endpoints": [],
"other_names": []
}Other providers in Lufkin, TX
- P & S Healthcare LP (Southland Health Care Center)
- P-CG LLC Dba Pineywoods Medical Billing (Pineywoods Medical Billing)
- Miriam Padilla
- Velta Page, LBSW-MHP
- Pain & Posture Care Centers of America P a
- David Patrick Palmer, R. PH.
- David T Palmer, D.D.S
- Pam Specialty Hospital of Lufkin, LLC (PAM Specialty Hospital of Lufkin)
- Larissa Allison Parham, CSW
- Parks Bell, Inc. (Cross Medical)
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 4, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.