Healthcare Provider Details

I. General information

NPI: 1982517892
Provider Name (Legal Business Name): ALEX WALLACE COUNSELING LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/23/2026
Last Update Date: 09/23/2026
Certification Date: 09/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3505 CALUMET RD
LUDLOW FALLS OH
45339-8776
US

IV. Provider business mailing address

3505 CALUMET RD
LUDLOW FALLS OH
45339-8776
US

V. Phone/Fax

Practice location:
  • Phone: 937-303-7333
  • Fax:
Mailing address:
  • Phone: 937-303-7333
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name: ALEX WALLACE
Title or Position: MEMBER
Credential:
Phone: 765-760-4772