MEDICARE: WALLACE COUNSELING COMPANY PLLC

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	101YP2500X	Professional Counselor

General Provider Information

NPI Number	:	1528916228
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	WALLACE COUNSELING COMPANY PLLC

Provider Business Mailing Address
First Line	:	4468 DUFF RD
Second Line	:
City	:	LIVINGSTON
State	:	TX
Zip	:	77351-5627
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	106 E MILAM ST
Second Line	:
City	:	LIVINGSTON
State	:	TX
Zip	:	77351-2936
Country	:	US
Telephone Number	:	936-933-9172
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	JENNIFER WALLACE
Credential	:
Telephone Number	:	936-215-1467

Provider Enumeration Date	:	03/18/2026
Last Update Date	:	03/18/2026

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