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NPI Code Detail

MEDICARE: NOVLET WALLACE LPC, NCC

MEDICARE: NOVLET WALLACE LPC, NCC
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
1101YP2500XProfessional Counselor86293TX
2101YM0800XMental Health Counselor86293TX

General Provider Information

NPI Number : 1093417636
Entity Type Code : Individual
Provider Name (Legal Business Name) : NOVLET WALLACE LPC, NCC
Provider Business Mailing Address
First Line : 1106 KATELYN CT
Second Line :
City : IRVING
State : TX
Zip : 75060-5775
Country : US
Telephone Number : 407-218-2898
Fax Number :
Provider Business Practice Location Address
First Line : 1020 S CARRIER PKWY
Second Line :
City : GRAND PRAIRIE
State : TX
Zip : 75051-1527
Country : US
Telephone Number : 214-330-2488
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/20/2023
Last Update Date : 12/08/2025

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