LISA M WALLACE (NPI# 1124002571) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1124002571 |
| Entity Type | Individual |
| Full Name | LISA M WALLACE |
| Credential | MA, LPC |
| Practice Address |
1807 Capitol Ave Suite 101 A Cheyenne WY 82001-4544 |
| Practice Telephone | 3076307875 |
| Practice Fax Number | 8778334460 |
| Mailing Telephone | 3076307875 |
| Mailing Fax Number | 8778334460 |
| Enumeration Date | 2005-11-30 |
| Last Update Date | 2009-05-08 |
| Gender Code | F |
| Is Sole Proprietor | Y |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 101YM0800X |
Counselor Specialization: Mental Health |
906 | WY | Behavioral Health & Social Service Providers |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| WY | BS OF WY | 312410 | 01 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1396368064 | Lisa Jean Wallace | Occupational Therapy Assistant | 480 Somerset St Unit 1, North Plainfield, NJ 07060-4018 | 2020-05-28 |
| 1336779925 | Lisa Wallace | Counselor | 2769 Iris Ave Ste 107, Boulder, CO 80304-4405 | 2020-01-22 |
| 1710521968 | Lisa Anne Wallace | Counselor | 418 Barr Rd, Lexington, SC 29072-2363 | 2019-10-31 |
| 1598225930 | Lisa Buckner Wallace | Counselor | 3750 N Center St, Hickory, NC 28601-8089 | 2019-03-21 |
| 1235637182 | Lisa M. Wallace | Nurse Practitioner | 800 E Cheves St Ste 200, Florence, SC 29506-2651 | 2018-01-25 |
| 1134575475 | Lisa Wallace | Counselor | 14 Farmer Rd, Milton, MA 02186-3743 | 2016-05-05 |
| 1720476641 | Lisa Wallace | Registered Nurse | 7601 Hospital Dr Ste 202, Sacramento, CA 95823-5408 | 2014-12-30 |
| 1134438286 | Lisa M Wallace | Nurse Practitioner | 831 N Theatre Drive, Marion, IN 46952-1701 | 2010-10-06 |
| 1003423658 | Lisa Carol Wallace | Nurse Practitioner | 2418 180th St, Allerton, IA 50008-8715 | 2020-09-28 |
| 1992368872 | Lisa Wallace | Licensed Practical Nurse | 27777 Inkster Rd, Farmington Hills, MI 48334-5326 | 2019-04-17 |
| Street Address |
1807 CAPITOL AVE SUITE 101 A |
| City | CHEYENNE |
| State | WY |
| Zip Code | 82001-4544 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1073819207 | Clinical Decision Medical Services, LLC | General Practice | 1807 Capitol Ave, Suite 201, Cheyenne, WY 82001-4544 | 2011-02-05 |
| 1609172204 | Frontier Critical Care Physicians, LLC | Internal Medicine | 1807 Capitol Ave, Ste 201, Cheyenne, WY 82001-4544 | 2011-01-31 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1194382150 | Brain Advancement Center, LLC | Counselor | 2005 Warren Ave., Cheyenne, WY 82001 | 2019-05-24 |
| 1255897385 | Humble Horizon Home Health LLC | Case Management | 6066 Wilderness Trl, Cheyenne, WY 82001 | 2019-02-13 |
| 1396214722 | Megan Kraushaar | Behavior Technician | 3120 Old Faithful Rd, Cheyenne, WY 82001 | 2018-11-14 |
| 1255815536 | Michelle Mae Mccoy | Social Worker | 2360 E Perishing Blvd, Cheyenne, WY 82001 | 2018-09-21 |
| 1750869616 | Finding Peace Counseling, LLC | Counselor | 1603 Capitol Ave Ste 510b, Cheyenne, WY 82001 | 2018-08-02 |
| 1457855595 | Better Life Counseling LLC | Counselor | 2909 Bent Ave Ste 5, Cheyenne, WY 82001 | 2018-03-22 |
| 1942729066 | Brittany Heinzman | Community Health Worker | 2000 Westland Road Suite C, Cheyenne, WY 82001 | 2017-09-11 |
| 1144768086 | Cheyenne Regional Home Home Care Services | Case Management | 214 E 23rd Street, Cheyenne, WY 82001 | 2017-02-10 |
| 1104360726 | Jennifer Pannebaker | Behavioral Analyst | 813 Randall Ave, Cheyenne, WY 82001 | 2016-12-16 |
| 1053854703 | Raven Coward Long | Social Worker | 821 East Pershing Blvd, Cheyenne, WY 82001 | 2016-11-29 |
| Find all providers in zip 82001 | ||||
| Taxonomy Code | 101YM0800X |
| Grouping | Behavioral Health & Social Service Providers |
| Classification | Counselor |
| Specialization | Mental Health |
| Definition to come... |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1356965719 | Jerry Tyrone Smith | Counselor | 6818 Pasadena Rd, Cheyenne, WY 82009-2812 | 2020-06-02 |
| 1427684877 | Ashley V Evans | Counselor | 1629 Washakie Loop Unit A, Cheyenne, WY 82001-7186 | 2020-03-18 |
| 1194382150 | Brain Advancement Center, LLC | Counselor | 2005 Warren Ave., Cheyenne, WY 82001 | 2019-05-24 |
| 1548748593 | Susan F Markus | Counselor | 4318 Green Prairie Pl, Cheyenne, WY 82001-2303 | 2018-08-01 |
| 1811365406 | Tera Campbell | Counselor | 1603 Capitol Ave Ste 303c, Cheyenne, WY 82001-4561 | 2015-09-13 |
| 1356762561 | Brandy June Edlund | Counselor | 106 E 27th St, Cheyenne, WY 82001-2817 | 2013-12-16 |
| 1205191541 | Eliza J Krall | Counselor | 1607 Capitol Ave Fl The2, Cheyenne, WY 82001-4525 | 2012-07-12 |
| 1467715078 | Lindsay C Simineo | Counselor | 1603 Capitol Ave Ste 402, Cheyenne, WY 82001-4562 | 2012-06-19 |
| 1083970875 | Tanya M Borden | Counselor | 903 S Greeley Hwy Ste A, Cheyenne, WY 82007-3057 | 2012-04-05 |
| 1942490792 | Amy M Myers | Counselor | 909 Talbot Ct, Cheyenne, WY 82001-2719 | 2007-07-27 |
| Find all providers in CHEYENNE | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.