SAMALA WALLACK LPC
NPI 1073995866
Counselor - Professional in Saint Louis, MO
About Samala Wallack Lpc NPPES
Official registry information on file with the National Plan and Provider Enumeration System.
SAMALA WALLACK LPC (NPI 1073995866) is an individual professional provider in Saint Louis, Missouri, licensed in Missouri (2015008989) and active in the NPI registry since June 2015. She is enrolled in Medicare PECOS and is a graduate of Other (2004).
NPPES Registry Identity
Specialties & Licenses
Accepted Insurance
Medicare Participation & PECOS CMS
Medicare enrollment, assignment, billing reassignment, and ordering and referring status from CMS.
Medicare Enrollment Status
Enrolled in Medicare (PECOS)
Samala Wallack Lpc is registered in the CMS Provider Enrollment, Chain and Ownership System (PECOS).
Medicare Billing Reassignment
Medicare enrollment records show Samala Wallack reassigns Medicare billing to 1 organization. The organization bills Medicare for the services this provider delivers there.
Bethesda, MD 20814
- Reassigned Medicare billing, Florida enrollment
- 81 clinicians in this Medicare group
Source: CMS Revalidation Reassignment List, October 2026 release. Reassignment records can lag staffing changes; confirm a current affiliation with the organization.
Other Providers at the Same Location NPPES 14
Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.
SAINT LOUIS, MO 63146
SAINT LOUIS, MO 63146
SAINT LOUIS, MO 63146
Frequently Asked Questions NPPES & CMS
Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.
What is Samala Wallack's NPI number?
The NPI number for Samala Wallack is 1073995866. It was assigned to this individual provider in the NPPES registry on June 29, 2015.
Where is Samala Wallack located?
Samala Wallack practices at 111 W Port Plz, Saint Louis, MO 63146. The listed phone number is (816) 404-5700.
What is Samala Wallack's specialty?
The primary specialty registered for this NPI is Counselor, specializing in Professional, with taxonomy code 101YP2500X.
Is Samala Wallack enrolled in Medicare?
Yes. Samala Wallack is registered in the Medicare PECOS enrollment system.
Which organization bills Medicare for Samala Wallack's services?
According to the CMS Revalidation Reassignment List (October 2026 release), Samala Wallack reassigns Medicare benefits to Uplift Behavioral Health PC (Bethesda, MD). The reassignment is filed with Medicare on form CMS-855R, signed by both the clinician and the organization, and lets the organization bill Medicare and receive payment for Samala Wallack's services. Reassignment records can lag staffing changes; confirm current arrangements with the organization.
What insurance does Samala Wallack accept?
Health plans from Anthem Blue Cross and Blue Shield, Blue Cross and Blue Shield of Kansas City, Cigna HealthCare of Florida, Inc., Cigna Healthcare and Florida Blue (BlueCross BlueShield FL) and 2 other insurers list Samala Wallack as in-network in at least one marketplace plan. Coverage varies by plan and year; verify with the insurer or the provider before a visit.
When was this NPI record last updated?
The NPPES record for Samala Wallack was last updated on June 23, 2026. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 4 months ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.
# Samala Wallack, LPC · NPI 1073995866
Professional provider in Saint Louis, Missouri. Individual provider, active in the CMS NPPES registry since June 29, 2015.
## Identity
- **NPI:** 1073995866 (Entity type: Individual)
- **Enumerated:** June 29, 2015
- **Primary specialty:** Counselor - Professional · taxonomy 101YP2500X
- **State license:** 2015008989 (Missouri)
- **Sole proprietor:** No
## Practice location
- **Address:** 111 W PORT PLZ, Saint Louis, MO 63146-3011
- **Phone:** (816) 404-5700
## Medicare
- **Medicare:** Enrolled in Medicare (PECOS)
- **Ordering & referring:** eligible for Part B labs & imaging, durable medical equipment
- **Bills Medicare through:** Uplift Behavioral Health PC (NPI 1629740410, Bethesda, MD), under Medicare reassignment (form CMS-855R) · CMS Revalidation Reassignment List, October 2026 release
- **Medical school:** Other, class of 2004
## Record status
- **NPPES last updated:** June 23, 2026
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Source: [NPI Profile](https://npiprofile.com/npi/1073995866) · Data from the CMS NPPES public registry.