MEDICARE: MISS BRITTANY K WALLACE LPC

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

General Provider Information

NPI Number	:	1215471347
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MISS BRITTANY K WALLACE LPC

Provider Business Mailing Address
First Line	:	303 W JEFFERSON ST
Second Line	:
City	:	AMERICUS
State	:	GA
Zip	:	31709-3523
Country	:	US
Telephone Number	:	470-737-5687
Fax Number	:

Provider Business Practice Location Address
First Line	:	303 W JEFFERSON ST
Second Line	:
City	:	AMERICUS
State	:	GA
Zip	:	31709-3523
Country	:	US
Telephone Number	:	470-737-5687
Fax Number	:

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

Provider Enumeration Date	:	12/08/2016
Last Update Date	:	02/25/2026

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