MEDICARE: MEGHAN WALLACE COUNSELING SERVICES

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	:	1578446217
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MEGHAN WALLACE COUNSELING SERVICES

Provider Business Mailing Address
First Line	:	413 WALLACE ST UNIT 2D
Second Line	:
City	:	PHILADELPHIA
State	:	PA
Zip	:	19123-2297
Country	:	US
Telephone Number	:	267-644-5258
Fax Number	:

Provider Business Practice Location Address
First Line	:	255 S 17TH ST STE 1504
Second Line	:
City	:	PHILADELPHIA
State	:	PA
Zip	:	19103-6215
Country	:	US
Telephone Number	:	215-362-3040
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	MEGHAN WALLACE
Credential	:	LPC
Telephone Number	:	215-362-3040

Provider Enumeration Date	:	07/29/2025
Last Update Date	:	07/29/2025

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