| Wallace Counseling, Llc | |
|
4115 Boardwalk Dr Suite 200 Fort Collins CO 80525-5945 | |
| (970) 817-4049 | |
| Not Available |
| Full Name | Wallace Counseling, Llc |
|---|---|
| Speciality | Counselor |
| Location | 4115 Boardwalk Dr, Fort Collins, Colorado |
| Authorized Official Name and Position | Lisa Wallace (PRIVATE PRACTITIONER) |
| Authorized Official Contact | 9708174049 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Wallace Counseling, Llc Po Box 273338 Fort Collins CO 80527-3338 Ph: (970) 817-4049 | Wallace Counseling, Llc 4115 Boardwalk Dr Suite 200 Fort Collins CO 80525-5945 Ph: (970) 817-4049 |
| NPI Number | 1396028544 |
|---|---|
| Provider Enumeration Date | 09/23/2011 |
| Last Update Date | 12/16/2015 |
| Medicare PECOS PAC ID | 7517306780 |
|---|---|
| Medicare Enrollment ID | O20240419003665 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1396028544 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 101YP2500X | Counselor - Professional | 5913 (Colorado) | Primary |
| Provider Name | Lisa M Wallace |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1124002571 PECOS PAC ID: 8426497694 Enrollment ID: I20240419003668 |
Wallace Counseling, Llc Mental Health Clinic Medicare: Not Enrolled in Medicare Practice Location: 4115 Boardwalk Dr, Suite 200, Fort Collins, CO 80525 Phone: 970-817-4049 Fax: 877-833-4460 | |
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