MEDICARE: JOANNE WALLACE M.A., LPC-S

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	70335	TX

General Provider Information

NPI Number	:	1831588433
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JOANNE WALLACE M.A., LPC-S

Provider Business Mailing Address
First Line	:	7711 HIDDEN OAKS LN
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77095-4735
Country	:	US
Telephone Number	:	281-865-4907
Fax Number	:

Provider Business Practice Location Address
First Line	:	7711 HIDDEN OAKS LN
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77095-4735
Country	:	US
Telephone Number	:	281-865-4907
Fax Number	:

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

Provider Enumeration Date	:	01/20/2015
Last Update Date	:	07/22/2024

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