MR. JEFFREY EUGENE WALLACE LICSW MSW CDP MHP NPI 1538557012

NPI Information

  • NPI: 1538557012
  • Provider Name: MR. JEFFREY EUGENE WALLACE, LICSW, MSW, CDP, MHP
  • Classification: Counselor - 101YM0800X
  • Specialization: Mental Health
  • Entity Type: Individual
  • PECOS Registration: Yes
  • Address: 400 S JEFFERSON ST STE 200
    SPOKANE, WA
    ZIP 99204
  • Phone: (509) 822-8662

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NPI Details

MR. Jeffrey Eugene Wallace, LICSW, MSW, CDP, MHP is a mental health counselor in Spokane, WA with 12 years of experience. MR. Jeffrey Eugene Wallace, LICSW, MSW, CDP, MHP NPI is 1538557012. The provider is registered as an individual entity type.

The NPPES NPI record indicates the provider is a male.

The provider's business location address is:

400 S JEFFERSON ST STE 200
SPOKANE, WA
ZIP 99204-143
Phone: (509) 822-8662

The NPI 1538557012 is registered in the Medicare Provider, Enrollment, Chain and Ownership System (PECOS). The provider is legally eligible to order and refer Part B (Clinical Laboratory and Imaging), Durable Medical Equipment.

The enumeration date for this NPI number is 1/6/2015 and was last updated on 1/28/2019.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No. Taxonomy Code Taxonomy Clasification Taxonomy Specialization License Number License State Primary
1101YA0400XCounselorAddiction (Substance Use Disorder)CO60490069WASHINGTONNo
2101YM0800XCounselorMental HealthSC60493319WASHINGTONYes
31041C0700XSocial WorkerClinicalSC60493319WASHINGTONNo

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 11/21/2025

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