Mr Jeffrey Eugene Wallace, LICSW, MSW, CDP, MHP is a
Counselor - Mental Health based in Spokane, Washington. Mr Jeffrey Eugene Wallace is licensed to practice in Washington (license number SC60493319) and his current practice location is
400 S Jefferson St Ste 200, Spokane, Washington. He can be reached at his office (for appointments etc.) via phone at
(509) 822-8662.
NPI number for Mr Jeffrey Eugene Wallace is 1538557012 and his current mailing address is 400 S Jefferson St Ste 200, Spokane, Washington. He
does not participate in medicare program and thus does not accept medicare assignments. His NPI Number is 1538557012.
Healthcare Provider's Profile
| Full Name | Mr Jeffrey Eugene Wallace |
|---|
| Gender | Male |
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| Speciality | Counselor - Mental Health |
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| Location | 400 S Jefferson St Ste 200, Spokane, Washington |
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| Accepts Medicare Assignments | Does not participate in Medicare Program. He may not accept medicare assignment. |
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NPI Data:
- NPI Number: 1538557012
- Provider Enumeration Date: 01/06/2015
- Last Update Date: 01/28/2019
Medical Identifiers
Medical identifiers for Mr Jeffrey Eugene Wallace such as npi, medicare ID, medicare PIN, medicaid, etc.
| Identifier | Type | State | Issuer |
|---|
| 1538557012 | NPI | - | NPPES |
Medical Taxonomies and Licenses
| Taxonomy | Type | License (State) | Status |
|---|
| 1041C0700X | Social Worker - Clinical | SC60493319 (Washington) | Secondary |
| 101YM0800X | Counselor - Mental Health | SC60493319 (Washington) | Primary |
| 101YA0400X | Counselor - Addiction (substance Use Disorder) | CO60490069 (Washington) | Secondary |
Medicare Part D Prescriber Enrollment
Any physician or other eligible professional who prescribes Part D drugs must either enroll in the Medicare program or opt out in order to prescribe drugs to their patients with Part D prescription drug benefit plans. Mr Jeffrey Eugene Wallace is
NOT enrolled with medicare and thus cannot prescribe medicare part D drugs to patients with medicare part D benefits.
Mailing Address and Practice Location
| Mailing Address | Practice Location Address |
|---|
Mr Jeffrey Eugene Wallace, LICSW, MSW, CDP, MHP
400 S Jefferson St Ste 200,
Spokane, WA 99204-3143
Ph: (509) 822-8662 | Mr Jeffrey Eugene Wallace, LICSW, MSW, CDP, MHP
400 S Jefferson St Ste 200,
Spokane, WA 99204-3143
Ph: (509) 822-8662 |
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