JUDITH WALLACE MAC, LAT
NPI 1205373107
Counselor - Professional in Sheridan, WY

Q: What is Judith Wallace's NPI number?

The NPI number for Judith Wallace is 1205373107. It was assigned to this individual provider in the NPPES registry on January 30, 2017.

Q: What is Judith Wallace's specialty?

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

Q: When was this NPI record last updated?

The NPPES record for Judith Wallace was last updated on January 30, 2026. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 6 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.

Active since January 30, 2017PECOS EnrolledAccepts Medicare Assignment

1221 W 5TH ST, SHERIDAN, WY 82801(307) 674-4405 Get Directions Write a Review

NPPES record last updated: January 30, 2026. Verified against the NPPES registry weekly; last sync: August 16, 2026.

Record update history: Jan 30, 2026, Apr 6, 2023, Apr 17, 2017 and 2 more (5 updates tracked since 2017).

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About Judith Wallace Mac, Lat NPPES

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

JUDITH WALLACE MAC, LAT (NPI 1205373107) is an individual professional provider in Sheridan, Wyoming, licensed in Wyoming (2478) and active in the NPI registry since January 2017. She is enrolled in Medicare PECOS and is a graduate of Other (2018).

NPPES Registry Identity

NPI1205373107

Entity TypeIndividualFemale

Primary Taxonomy101YP2500X

Provider Legal NameJUDITH WALLACECredential: MAC, LAT

Location Address1221 W 5TH STSheridan, WY 82801-2701

Mailing Address1221 W 5th StSheridan, WY 82801-2701 · (307) 674-4405

Phone(307) 674-4405

Sole ProprietorNo

Medical School CMSOtherGraduated 2018

Enumeration DateJanuary 30, 2017

Last NPPES UpdateJanuary 30, 20265 updates tracked since enumeration

NPPES CertifiedJanuary 30, 2026

✔ NPI 1205373107 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses 4

★ Primary SpecialtyCounselor · ProfessionalBehavioral Health & Social Service Providers

Taxonomy Code101YP2500X

License✔ Licensed in WY · 2478

Also ListedCounselor · Addiction (Substance Use Disorder)Taxonomy 101YA0400X · License 352 (WY)

Also ListedCounselor · Mental HealthTaxonomy 101YM0800X · License 1359 (WY)

Also ListedAcupuncturistTaxonomy 171100000X · License A-030 (WY)

1221 W 5TH ST, Sheridan, WY 82801

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Accepted Insurance

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

Medicare Participation & PECOS CMS

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

Medicare Enrollment Status

✔

Enrolled in Medicare and accepts Medicare assignment

Judith Wallace Mac, Lat is registered in PECOS and agrees to accept the Medicare-approved amount as full payment. Medicare patients are not billed beyond the standard deductible and coinsurance.

PECOS PAC ID8820539083

PECOS Enrollment IDI20240916002652

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.

Other Providers at the Same Location NPPES 20

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

VOLUNTEERS OF AMERICA NORTHERN ROCKIES

Clinic/Center (Rehabilitation, Substance Use Disorder)