MEDICARE: BARBARA WALLACE LICSW

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YM0800X	Mental Health Counselor	LICSW5597C	AL

General Provider Information

NPI Number	:	1164287793
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BARBARA WALLACE LICSW

Provider Business Mailing Address
First Line	:	PO BOX 2409
Second Line	:
City	:	HUNTSVILLE
State	:	AL
Zip	:	35804-2409
Country	:	US
Telephone Number	:	256-536-4700
Fax Number	:

Provider Business Practice Location Address
First Line	:	3500 MEMORIAL PKWY SW
Second Line	:
City	:	HUNTSVILLE
State	:	AL
Zip	:	35801-5318
Country	:	US
Telephone Number	:	256-536-4700
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/13/2024
Last Update Date	:	06/02/2026

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