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TRACIE WALLACE LPC
NPI 1306224613
Counselor - Professional in Saint Louis, MO

Active since May 07, 2015Opted out of Medicare · through Mar 25, 2028
1023 EXECUTIVE PARKWAY DR STE 10, SAINT LOUIS, MO 63141(314) 469-5522(314) 469-5504 Get Directions Write a Review

NPPES record last updated: May 7, 2015. Verified against the NPPES registry weekly; last sync: August 02, 2026.

About Tracie Wallace Lpc NPPES

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

TRACIE WALLACE LPC (NPI 1306224613) is an individual professional provider in Saint Louis, Missouri, licensed in Missouri (2012029763) and active in the NPI registry since May 2015. She has opted out of Medicare through March 25, 2028.

NPPES Registry Identity

NPI1306224613
Entity TypeIndividualFemale
Primary Taxonomy101YP2500X
Provider Legal NameTRACIE WALLACECredential: LPC
Location Address1023 EXECUTIVE PARKWAY DR STE 10Saint Louis, MO 63141-6323
Mailing Address1023 Executive Parkway Dr Ste 10Saint Louis, MO 63141-6323 · (314) 469-5522 · Fax (314) 469-5504
Phone(314) 469-5522
Fax(314) 469-5504
Sole ProprietorYes
Enumeration DateMay 7, 2015
✔ NPI 1306224613 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyCounselor · ProfessionalBehavioral Health & Social Service Providers
Taxonomy Code101YP2500X
License✔ Licensed in MO · 2012029763
1023 EXECUTIVE PARKWAY DR STE 10, Saint Louis, MO 63141
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Accepted Insurance

The full list of accepted plans is on the Insurance tab. Issuers include Medica, Oscar Insurance Company, UnitedHealthcare.Insurance ›

Medicare Participation & PECOS CMS

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

Medicare Enrollment Status

ⓘ

Opted out of Medicare

Tracie Wallace Lpc has filed a Medicare opt-out affidavit. Services are provided under private contract between the provider and the patient, and are not billed to or reimbursed by Medicare. The opt-out is on file from March 25, 2026 through March 25, 2028.

Opt-Out Effective DateMarch 25, 2026
Opt-Out In Effect ThroughMarch 25, 2028Opt-out affidavits renew automatically every two years unless cancelled

Other Providers at the Same Location NPPES 10

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

LILIAN M WERNER MAC, LPC
Counselor
1023 EXECUTIVE PARKWAY DR STE 10
SAINT LOUIS, MO 63141
St. Louis County (314) 469-5522
SARA KAY COKER
Counselor (Mental Health)
1023 EXECUTIVE PARKWAY DR STE 10
SAINT LOUIS, MO 63141
St. Louis County (314) 469-5522
JOEL CHAPPEAU MAC, LPC
Counselor (Professional)
1023 EXECUTIVE PARKWAY DR STE 10
SAINT LOUIS, MO 63141
St. Louis County (314) 469-5522
DORINDA PEYTON LPC
Counselor (Professional)
1023 EXECUTIVE PARKWAY DR STE 10
SAINT LOUIS, MO 63141
St. Louis County (314) 469-5522
GINA MARIE BIRKEMEIER
Counselor (Professional)
1023 EXECUTIVE PARKWAY DR STE 10
SAINT LOUIS, MO 63141
St. Louis County (314) 469-5522
MRS. PATRICIA A. ROOSEVELT LPC
Counselor (Professional)
1023 EXECUTIVE PARKWAY DR STE 10
SAINT LOUIS, MO 63141
St. Louis County (314) 469-5522
CHAD RICHARD FRIZZELL LPC
Counselor (Professional)
1023 EXECUTIVE PARKWAY DR STE 10
SAINT LOUIS, MO 63141
St. Louis County (314) 469-5522
DR. JEREMY RUCKSTAETTER PHD, LPC, NCC
Counselor (Professional)
1023 EXECUTIVE PARKWAY DR STE 10
SAINT LOUIS, MO 63141
St. Louis County (314) 469-5522

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 Tracie Wallace's NPI number?

The NPI number for Tracie Wallace is 1306224613. It was assigned to this individual provider in the NPPES registry on May 7, 2015.

Where is Tracie Wallace located?

Tracie Wallace practices at 1023 Executive Parkway Dr Ste 10, Saint Louis, MO 63141. The listed phone number is (314) 469-5522.

What is Tracie Wallace's specialty?

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

Is Tracie Wallace enrolled in Medicare?

No. Tracie Wallace has opted out of Medicare through March 25, 2028. Care is provided under private contracts, and Medicare does not pay for services furnished by providers who have opted out.

What insurance does Tracie Wallace accept?

Health plans from Medica, Oscar Insurance Company and UnitedHealthcare list Tracie 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 Tracie Wallace was last updated on May 7, 2015. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 11 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.