| Wallace Mental Health & Addiction Counseling Llc | |
|
1810 Saddlewood Pl Bartow FL 33830-2917 | |
| (863) 529-3725 | |
| Not Available |
| Full Name | Wallace Mental Health & Addiction Counseling Llc |
|---|---|
| Speciality | Social Worker |
| Location | 1810 Saddlewood Pl, Bartow, Florida |
| Authorized Official Name and Position | Reginal A. Wallace (LICENSED CLINICIAN SOCIAL WORKER) |
| Authorized Official Contact | 8635293725 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Wallace Mental Health & Addiction Counseling Llc 1810 Saddlewood Pl Bartow FL 33830-2917 Ph: (863) 529-3725 | Wallace Mental Health & Addiction Counseling Llc 1810 Saddlewood Pl Bartow FL 33830-2917 Ph: (863) 529-3725 |
| NPI Number | 1730817149 |
|---|---|
| Provider Enumeration Date | 08/12/2022 |
| Last Update Date | 08/12/2022 |
| Certification Date | 08/12/2022 |
| Medicare PECOS PAC ID | 5193195881 |
|---|---|
| Medicare Enrollment ID | O20221221000003 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1730817149 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1041C0700X | Social Worker - Clinical | (* (Not Available)) | Primary |
| Provider Name | Reginal A Wallace |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1205400066 PECOS PAC ID: 1355740911 Enrollment ID: I20210602000232 |
Polk Halfway House Mental Health Clinic Medicare: Not Enrolled in Medicare Practice Location: 2145 Bob Phillips Rd, Bartow, FL 33830 Phone: 863-519-5581 Fax: 863-519-6603 | |
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The Mid-florida Center, Inc. Mental Health Clinic Medicare: Not Enrolled in Medicare Practice Location: 555 W Main St, Bartow, FL 33830 Phone: 863-533-2321 Fax: 863-533-4870 | |
Children's Home Society Of Florida Mental Health Clinic Medicare: Not Enrolled in Medicare Practice Location: 1260 Golfview Ave, Bartow, FL 33830 Phone: 407-375-2565 | |
Polk Halfway House Mental Health Clinic Medicare: Not Enrolled in Medicare Practice Location: 2145 Bob Phillips Rd, Bartow, FL 33830 Phone: 863-519-5581 Fax: 863-519-6603 | |
Bridge To Care - Us Inc. Mental Health Clinic Medicare: Not Enrolled in Medicare Practice Location: 1415 E Georgia St, Bartow, FL 33830 Phone: 509-792-7346 | |
Bay Area Behavioral Services Mental Health Clinic Medicare: Not Enrolled in Medicare Practice Location: 113 E Main St, Suite # 7, Bartow, FL 33830 Phone: 813-689-8828 Fax: 813-689-8802 |