MR. JEFFREY EUGENE WALLACE LICSW, MSW, CDP, MHP
NPI 1538557012
Counselor - Mental Health in Spokane, WA

Q: What is Jeffrey Wallace's NPI number?

The NPI number for Jeffrey Wallace is 1538557012. It was assigned to this individual provider in the NPPES registry on January 6, 2015. The provider is also known as Jeff Wallace Rev., M.Div..

Q: What is Jeffrey Wallace's specialty?

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

Q: When was this NPI record last updated?

The NPPES record for Jeffrey Wallace was last updated on January 28, 2019. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 7 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.

Active since January 06, 2015PECOS EnrolledAccepts Medicare Assignment

400 S JEFFERSON ST STE 200, SPOKANE, WA 99204(509) 822-8662 Get Directions Write a Review

NPPES record last updated: January 28, 2019. Verified against the NPPES registry weekly; last sync: August 16, 2026.

On this page

About Mr. Jeffrey Eugene Wallace Licsw, Msw, Cdp, Mhp NPPES

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

MR. JEFFREY EUGENE WALLACE LICSW, MSW, CDP, MHP (NPI 1538557012) is an individual mental health provider in Spokane, Washington, licensed in Washington (SC60493319) and active in the NPI registry since January 2015. He is enrolled in Medicare PECOS and is a graduate of Other (2014).

NPPES Registry Identity

NPI1538557012

Entity TypeIndividualMale

Primary Taxonomy101YM0800X

Provider Legal NameMR. JEFFREY EUGENE WALLACECredential: LICSW, MSW, CDP, MHP

Location Address400 S JEFFERSON ST STE 200Spokane, WA 99204-3143

Mailing Address400 S Jefferson St Ste 200Spokane, WA 99204-3143 · (509) 822-8662

Phone(509) 822-8662

Sole ProprietorYes

Medical School CMSOtherGraduated 2014

Enumeration DateJanuary 6, 2015

Last NPPES UpdateJanuary 28, 2019

✔ NPI 1538557012 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses 3

★ Primary SpecialtyCounselor · Mental HealthBehavioral Health & Social Service Providers

Taxonomy Code101YM0800X

License✔ Licensed in WA · SC60493319

Also ListedCounselor · Addiction (Substance Use Disorder)Taxonomy 101YA0400X · License CO60490069 (WA)

Also ListedSocial Worker · ClinicalTaxonomy 1041C0700X · License SC60493319 (WA)

400 S JEFFERSON ST STE 200, Spokane, WA 99204

Open in Google Maps ↗

Other Names 1

Other Name (5)Jeff Wallace Rev., M.div.

Accepted Insurance

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

Mr. Jeffrey Eugene Wallace Licsw, Msw, Cdp, Mhp 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 ID6901340884

PECOS Enrollment IDI20240702003499

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 16

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

TIFFANY COURY BIGGINS

Counselor (Mental Health)