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MARY WALLACE
NPI 1255760898
Counselor - Mental Health in Vancouver, WA

Active since November 04, 2013PECOS EnrolledAccepts Medicare Assignment
400 NE MOTHER JOSEPH PL, VANCOUVER, WA 98664(360) 514-2216(360) 514-6527 Get Directions Write a Review

NPPES record last updated: December 22, 2021. Verified against the NPPES registry weekly; last sync: November 01, 2026.

Record update history: Dec 22, 2021, Aug 10, 2021 (2 updates tracked since 2021).

About Mary Wallace NPPES

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

MARY WALLACE (NPI 1255760898) is an individual mental health provider in Vancouver, Washington, licensed in Washington (LH61086337) and active in the NPI registry since November 2013. She is enrolled in Medicare PECOS, maintains a secondary practice location in Portland, and is a graduate of Other (2015).

NPPES Registry Identity

NPI1255760898
Entity TypeIndividualFemale
Primary Taxonomy101YM0800X
Provider Legal NameMARY WALLACE
Location Address400 NE MOTHER JOSEPH PLVancouver, WA 98664-3200
Mailing AddressPo Box 8459Portland, OR 97207-8459
Phone(360) 514-2216
Fax(360) 514-6527
Sole ProprietorNo
Medical School CMSOtherGraduated 2015
Enumeration DateNovember 4, 2013
Last NPPES UpdateDecember 22, 20212 updates tracked since enumeration
NPPES CertifiedDecember 22, 2021
✔ NPI 1255760898 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses 2

★ Primary SpecialtyCounselor · Mental HealthBehavioral Health & Social Service Providers
Taxonomy Code101YM0800X
License✔ Licensed in WA · LH61086337
Also ListedAdult CompanionTaxonomy 372600000X
400 NE MOTHER JOSEPH PL, Vancouver, WA 98664
Open in Google Maps ↗

Secondary Practice Location 1

Location 11818 SE Division StPortland, OR 97202-1159 · Phone (503) 963-7619

Accepted Insurance

The full list of accepted plans is on the Insurance tab. Issuers include Ambetter Health, BridgeSpan Health Company, Kaiser Permanente and more.Insurance ›

Medicare Participation & PECOS CMS

Medicare enrollment, assignment, billing reassignment, and ordering and referring status from CMS.

Medicare Enrollment Status

✔

Enrolled in Medicare and accepts Medicare assignment

Mary Wallace 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 ID5991157406
PECOS Enrollment IDI20240121000069
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.

Medicare Billing Reassignment

Medicare enrollment records show Mary Wallace reassigns Medicare billing to 1 organization. The organization bills Medicare for the services this provider delivers there.

Peacehealth
Same address
General Acute Care Hospital
400 NE MOTHER JOSEPH PL
Vancouver, WA 98664
  • Reassigned Medicare billing, Washington enrollment
  • 244 clinicians in this Medicare group
NPI 1134178999 (360) 256-2000

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 20

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

DR. TYLER JUSTIN PARADIS MD
Anesthesiology
400 NE MOTHER JOSEPH PL
VANCOUVER, WA 98664
Clark County (360) 828-5396
MACKENZIE RHOADES APRN-CNP, PMHNP-BC
Clinical Nurse Specialist (Psychiatric/Mental Health)
400 NE MOTHER JOSEPH PL
VANCOUVER, WA 98664
Clark County (360) 256-2000
ALBERT MATTHEW DICKAN
Psychiatry & Neurology (Psychiatry)
400 NE MOTHER JOSEPH PL
VANCOUVER, WA 98664
Clark County (360) 514-3191
BRADDEN JENSEN MD
Pathology (Anatomic Pathology & Clinical Pathology)
400 NE MOTHER JOSEPH PL
VANCOUVER, WA 98664
Clark County (360) 514-2116
DR. RAMON LARIOS MD
Anesthesiology
400 NE MOTHER JOSEPH PL
VANCOUVER, WA 98664
Clark County (360) 828-5396
WESLEY HANSON PHARMD
Pharmacist
400 NE MOTHER JOSEPH PL
VANCOUVER, WA 98664
Clark County (360) 514-2881
HENRY NGUYEN PHARMD
Pharmacist
400 NE MOTHER JOSEPH PL
VANCOUVER, WA 98664
Clark County (360) 514-2000
DR. GREGORY A CONNELL M.D.
Anesthesiology
400 NE MOTHER JOSEPH PL
VANCOUVER, WA 98664
Clark County (360) 667-3056

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 Mary Wallace's NPI number?

The NPI number for Mary Wallace is 1255760898. It was assigned to this individual provider in the NPPES registry on November 4, 2013.

Where is Mary Wallace located?

Mary Wallace practices at 400 NE Mother Joseph Pl, Vancouver, WA 98664. The listed phone number is (360) 514-2216.

What is Mary Wallace's specialty?

The primary specialty registered for this NPI is Counselor, specializing in Mental Health, with taxonomy code 101YM0800X.

Is Mary Wallace enrolled in Medicare?

Yes. Mary Wallace is registered in the Medicare PECOS system and accepts Medicare assignment, which means accepting the Medicare-approved amount as payment in full for covered services.

Which organization bills Medicare for Mary Wallace's services?

According to the CMS Revalidation Reassignment List (October 2026 release), Mary Wallace reassigns Medicare benefits to Peacehealth (Vancouver, WA). 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 Mary Wallace's services. Reassignment records can lag staffing changes; confirm current arrangements with the organization.

What insurance does Mary Wallace accept?

Health plans from Ambetter Health, BridgeSpan Health Company, Kaiser Permanente, Moda Health Plan, Inc. and PacificSource Health Plans and 1 other insurer list Mary 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 Mary Wallace was last updated on December 22, 2021. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 4 years 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.