JERRYD WALLACE (NPI# 1821573387) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1821573387 |
| Entity Type | Individual |
| Full Name | JERRYD WALLACE |
| Credential | LPC |
| Practice Address |
162 N. Dallas Ave Van Alstyne TX 75495-7549 |
| Mailing Address |
Po Box 2020 Van Alstyne TX 75495-2020 |
| Practice Telephone | 4696673515 |
| Mailing Telephone | 4696673515 |
| Enumeration Date | 2018-10-01 |
| Last Update Date | 2018-10-01 |
| Gender Code | M |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 101YP2500X |
Counselor Specialization: Professional |
77418 | TX | Behavioral Health & Social Service Providers |
| Street Address |
162 N. DALLAS AVE |
| City | VAN ALSTYNE |
| State | TX |
| Zip Code | 75495-7549 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1922583483 | Hope for Home Counseling | Clinic/Center | 162 N. Dallas Ave, Van Alstyne, TX 75495-7549 | 2018-10-01 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1982262614 | Darshna Shahiwala | Nurse Practitioner | 920 W. Van Alstyne Parkway, Van Alstyne, TX 75495 | 2019-05-29 |
| 1841761806 | E-authority Inc. | Durable Medical Equipment & Medical Supplies | 225 West Van Alstyne Parkway, Suite 6, Van Alstyne, TX 75495 | 2018-12-16 |
| 1164942272 | Expecare, Lp | Clinic/Center | 920 West Van Alstyne Parkway, Van Alstyne, TX 75495 | 2017-06-21 |
| 1316373525 | G. G. & W. Health Services, LLC | Home Health | 260 East Marshall, Van Alstyne, TX 75495 | 2013-09-19 |
| 1679914196 | Town and Country Home Care & Rehab, LLC | Home Health | 178 S. Main St., Van Alstyne, TX 75495 | 2013-07-12 |
| 1891134912 | Texas Medical and Urgent Care Center Pllc | Clinic/Center | Rear 954 Van Alstyne Parkway, Van Alstyne, TX 75495 | 2013-06-21 |
| 1205129038 | Mika Sue English | Pharmacist | 232 East Jefferson, Van Alstyne, TX 75495 | 2011-05-26 |
| 1780988444 | Bryan Kelly Kincannon | Physical Therapy Assistant | 632 Windsor Way, Van Alstyne, TX 75495 | 2011-01-10 |
| 1598080640 | Luv Medgroup LLC | Durable Medical Equipment & Medical Supplies | 162 South Main St, Van Alstyne, TX 75495 | 2010-04-01 |
| 1194962324 | David W. Schatz | Pharmacist | 209 E. Jefferson St., Van Alstyne, TX 75495 | 2009-01-09 |
| Find all providers in zip 75495 | ||||
| Taxonomy Code | 101YP2500X |
| Grouping | Behavioral Health & Social Service Providers |
| Classification | Counselor |
| Specialization | Professional |
| Definition to come... |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1639320625 | Lester Isaac Bloomenstiel | Counselor | 7454 Fm 121, Van Alstyne, TX 75495-0776 | 2008-10-08 |
| 1942614839 | Cara Mcleod | Counselor | 524 N Lincoln Park Rd, Van Alstyne, TX 75495-5012 | 2014-06-18 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1093316903 | Christi Shortes | Counselor | 5024 Fm 304, Corsicana, TX 75109 | 2020-11-06 |
| 1265033047 | Rosa Isela Vidal | Counselor | 710 W Dove Ave, Pharr, TX 78577-9080 | 2020-11-06 |
| 1245831841 | Armando Martinez Jr. | Counselor | 2321 Nightingale Ave, Mcallen, TX 78504-4246 | 2020-11-02 |
| 1386245850 | Sondra Whitaker | Counselor | 19827 Billineys Park Dr, Katy, TX 77449-8538 | 2020-11-02 |
| 1902407430 | John Woodruff | Counselor | 206 S Kentucky St Ste 101, Mckinney, TX 75069-5439 | 2020-11-02 |
| 1063013589 | Infinite Beings Treatment Center LLC | Counselor | 4201 Cypress Creek Pkwy Ste 250, Houston, TX 77068-3412 | 2020-11-02 |
| 1821698531 | Stephenie Johnson | Counselor | 603 Ellington, Ropesville, TX 79358 | 2020-10-30 |
| 1770183477 | Yoonkyung Chung | Counselor | 312 W Westway Ave, Mcallen, TX 78501-2179 | 2020-10-30 |
| 1104426824 | Debrah Lynn Alsobrook | Counselor | 6601 Cypresswood Dr Ste 224, Spring, TX 77379-7893 | 2020-10-30 |
| 1134729106 | Provost Psychotherapy | Counselor | 1300 Bay Area Blvd Ste B150-28, Houston, TX 77058-2505 | 2020-10-29 |
| Find all providers with the same taxonomy | ||||
| City | VAN ALSTYNE |
| Zip Code | 75495 |
Please comment or provide details below to improve the information on JERRYD WALLACE.
| 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.