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
Entity Type: Individual

Specialization: Mental Health

Address:
400 S JEFFERSON ST STE 200
SPOKANE, WA
ZIP 99204
Phone: (509) 822-8662
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MR. Jeffrey Eugene Wallace, LICSW, MSW, CDP, MHP is a mental health counselor in Spokane, WA. 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 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
1	101YA0400X	Counselor	Addiction (Substance Use Disorder)	CO60490069	WASHINGTON	No
2	101YM0800X	Counselor	Mental Health	SC60493319	WASHINGTON	Yes
3	1041C0700X	Social Worker	Clinical	SC60493319	WASHINGTON	No

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: 4/28/2024

NPI Synchronization or Removal

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