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LISA M WALLACE MA, LPC
NPI 1124002571
Counselor - Professional in Fort Collins, CO

Active since November 30, 2005PECOS Enrolled
4103 E BOARDWALK DRIVE, SUITE 202, FORT COLLINS, CO 80525(970) 817-4049(877) 833-4460 Get Directions Write a Review

NPPES record last updated: December 1, 2025. Verified against the NPPES registry weekly; last sync: August 09, 2026.

Record update history: Dec 1, 2025, Mar 15, 2021 (2 updates tracked since 2021).

About Lisa M Wallace Ma, Lpc NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

LISA M WALLACE MA, LPC (NPI 1124002571) is an individual professional provider in Fort Collins, Colorado, licensed in Colorado (5913) and active in the NPI registry since November 2005. She is enrolled in Medicare PECOS.

NPPES Registry Identity

NPI1124002571
Entity TypeIndividualFemale
Primary Taxonomy101YP2500X
Provider Legal NameLISA M WALLACECredential: MA, LPC
Location Address4103 E BOARDWALK DRIVE, SUITE 202Fort Collins, CO 80525-5930
Mailing AddressPo Box 273338Fort Collins, CO 80527-3338 · (970) 817-4049 · Fax (877) 833-4460
Phone(970) 817-4049
Fax(877) 833-4460
Sole ProprietorNo
Enumeration DateNovember 30, 2005
Last NPPES UpdateDecember 1, 20252 updates tracked since enumeration
NPPES CertifiedDecember 1, 2025
✔ NPI 1124002571 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyCounselor · ProfessionalBehavioral Health & Social Service Providers
Taxonomy Code101YP2500X
Licenses✔ Licensed in CO · 5913✔ Licensed in WY · 906
4103 E BOARDWALK DRIVE, Fort Collins, CO 80525
Open in Google Maps ↗

Other Identifiers 1

Other312410WY · Bs Of Wy

Accepted Insurance

The full list of accepted plans is on the Insurance tab. Issuers include Blue Cross Blue Shield of Wyoming, Oscar Insurance Company, Providence Health Plan and more.Insurance ›

Medicare Participation & PECOS CMS

Medicare enrollment, assignment, and ordering and referring status from the CMS PECOS system.

Medicare Enrollment Status

✔

Enrolled in Medicare (PECOS)

Lisa M Wallace Ma, Lpc is registered in the CMS Provider Enrollment, Chain and Ownership System (PECOS).

Eligible to Order & Refer✔ Part B Labs & Imaging✔ Durable Medical Equipment– Home Health Agency– Power Mobility DevicesPer the CMS Ordering and Referring file. Eligibility means Medicare pays claims that this provider orders or refers for these categories.

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 Lisa Wallace's NPI number?

The NPI number for Lisa Wallace is 1124002571. It was assigned to this individual provider in the NPPES registry on November 30, 2005.

Where is Lisa Wallace located?

Lisa Wallace practices at 4103 E Boardwalk Drive Suite 202, Fort Collins, CO 80525. The listed phone number is (970) 817-4049.

What is Lisa Wallace's specialty?

The primary specialty registered for this NPI is Counselor, specializing in Professional, with taxonomy code 101YP2500X.

Is Lisa Wallace enrolled in Medicare?

Yes. Lisa Wallace is registered in the Medicare PECOS enrollment system.

What insurance does Lisa Wallace accept?

Health plans from Blue Cross Blue Shield of Wyoming, Oscar Insurance Company, Providence Health Plan and UnitedHealthcare list Lisa Wallace 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 Lisa Wallace was last updated on December 1, 2025. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 8 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.