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TY LAMAR WALLACE MSW
NPI 1295257624
Social Worker - Clinical in Pinckneyville, IL

Active since July 07, 2017
4904 BOWLS BOTTOM RD, PINCKNEYVILLE, IL 62274(618) 926-6050 Get Directions Write a Review

NPPES record last updated: July 21, 2022. Verified against the NPPES registry weekly; last sync: November 01, 2026.

Record update history: Jul 21, 2022, Jul 7, 2017 (2 updates tracked since 2017).

About Ty Lamar Wallace Msw NPPES

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

TY LAMAR WALLACE MSW (NPI 1295257624) is an individual clinical provider in Pinckneyville, Illinois, licensed in Illinois (149-010121) and active in the NPI registry since July 2017.

NPPES Registry Identity

NPI1295257624
Entity TypeIndividualMale
Primary Taxonomy1041C0700X
Provider Legal NameTY LAMAR WALLACECredential: MSW
Location Address4904 BOWLS BOTTOM RDPinckneyville, IL 62274-2453
Mailing Address4904 Bowls Bottom RdPinckneyville, IL 62274-2453 · (618) 926-6050
Phone(618) 926-6050
Sole ProprietorYes
Enumeration DateJuly 7, 2017
Last NPPES UpdateJuly 21, 20222 updates tracked since enumeration
✔ NPI 1295257624 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtySocial Worker · ClinicalBehavioral Health & Social Service Providers
Taxonomy Code1041C0700X
License✔ Licensed in IL · 149-010121
Definition
A social worker who holds a master's or doctoral degree in social work from an accredited school of social work in addition to at least two years of post-master's supervised experience in a clinical setting. The social worker must be licensed, certified, or registered at the clinical level in the jurisdiction of practice. A clinical social worker provides direct services, including interventions focused on interpersonal interactions, intrapsychic dynamics, and life management issues. Clinical social work services are based on bio-psychosocial perspectives. Services consist of assessment, diagnosis, treatment (including psychotherapy and counseling), client-centered advocacy, consultation, evaluation, and prevention of mental illness, emotional, or behavioral disturbances.
4904 BOWLS BOTTOM RD, Pinckneyville, IL 62274
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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 Ty Wallace's NPI number?

The NPI number for Ty Wallace is 1295257624. It was assigned to this individual provider in the NPPES registry on July 7, 2017.

Where is Ty Wallace located?

Ty Wallace practices at 4904 Bowls Bottom Rd, Pinckneyville, IL 62274. The listed phone number is (618) 926-6050.

What is Ty Wallace's specialty?

The primary specialty registered for this NPI is Social Worker, specializing in Clinical, with taxonomy code 1041C0700X.

When was this NPI record last updated?

The NPPES record for Ty Wallace was last updated on July 21, 2022. 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.