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PATRICK JOHN WALLACE JR.
NPI 1811853112
Counselor - Mental Health in Maple Grove, MN

Active since December 30, 2025
13603 80TH CIR N, MAPLE GROVE, MN 55369(763) 274-3120(763) 274-3121 Get Directions Write a Review

NPPES record last updated: December 30, 2025. Verified against the NPPES registry weekly; last sync: August 23, 2026.

About Patrick John Wallace Jr. NPPES

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

PATRICK JOHN WALLACE JR. (NPI 1811853112) is an individual mental health provider in Maple Grove, Minnesota and active in the NPI registry since December 2025.

NPPES Registry Identity

NPI1811853112
Entity TypeIndividualMale
Primary Taxonomy101YM0800X
Provider Legal NamePATRICK JOHN WALLACE JR.
Location Address13603 80TH CIR NMaple Grove, MN 55369-8961
Mailing Address909 Gould Ave Ne Apt 329Columbia Heights, MN 55421-4718 · (502) 287-9277
Phone(763) 274-3120
Fax(763) 274-3121
Sole ProprietorNo
Enumeration DateDecember 30, 2025
NPPES CertifiedDecember 30, 2025
✔ NPI 1811853112 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyCounselor · Mental HealthBehavioral Health & Social Service Providers
Taxonomy Code101YM0800X
13603 80TH CIR N, Maple Grove, MN 55369
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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.

DAVID M. KOSFELD LMFT
Marriage & Family Therapist
13603 80TH CIR N
MAPLE GROVE, MN 55369
Hennepin County (763) 274-3120
DR. ANITA THAMPY M.D
Psychiatry & Neurology (Psychiatry)
13603 80TH CIR N
MAPLE GROVE, MN 55369
Hennepin County (763) 274-3120
AMOS KOUKOU MSW, LGSW
Social Worker (Clinical)
13603 80TH CIR N
MAPLE GROVE, MN 55369
Hennepin County (763) 274-3120
DANIEL KNUDSON LADC
Counselor (Addiction (Substance Use Disorder))
13603 80TH CIR N
MAPLE GROVE, MN 55369
Hennepin County (763) 274-3120
BLAKE MALLOY
Counselor (Mental Health)
13603 80TH CIR N
MAPLE GROVE, MN 55369
Hennepin County (763) 274-3120
DERELLE R MORRISON
Marriage & Family Therapist
13603 80TH CIR N
MAPLE GROVE, MN 55369
Hennepin County (763) 274-3120
MARTHA SEPULVEDA
Counselor (Mental Health)
13603 80TH CIR N
MAPLE GROVE, MN 55369
Hennepin County (763) 284-3706
DR. ROCHELLE ELIZABETH MCCOURTNEY GREDVIG PSYD
Psychologist (Counseling)
13603 80TH CIR N
MAPLE GROVE, MN 55369
Hennepin County (763) 274-3120

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 Patrick Wallace's NPI number?

The NPI number for Patrick Wallace is 1811853112. It was assigned to this individual provider in the NPPES registry on December 30, 2025.

Where is Patrick Wallace located?

Patrick Wallace practices at 13603 80th Cir N, Maple Grove, MN 55369. The listed phone number is (763) 274-3120.

What is Patrick Wallace's specialty?

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

When was this NPI record last updated?

The NPPES record for Patrick Wallace was last updated on December 30, 2025. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 8 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.