MEDICARE: MS. ELIZABETH WALLACE NEU LPCC

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	CC04784	MN

General Provider Information

NPI Number	:	1851101752
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. ELIZABETH WALLACE NEU LPCC

Provider Business Mailing Address
First Line	:	9065 JUNEAU DR
Second Line	:
City	:	WOODBURY
State	:	MN
Zip	:	55125-3514
Country	:	US
Telephone Number	:	952-484-8108
Fax Number	:

Provider Business Practice Location Address
First Line	:	3503 HIGH POINT DR N, BUILDING 3, SUITE 203
Second Line	:
City	:	SAINT PAUL
State	:	MN
Zip	:	55128
Country	:	US
Telephone Number	:	952-479-0033
Fax Number	:

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

Provider Enumeration Date	:	01/13/2025
Last Update Date	:	02/20/2026

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