Lisa Wallace

LBN: Lisa Wallace
Lisa Wallace is an health care organization with primary practice located at 20200 Governors Dr 107, Olympia Fields IL 60461-1032. The organization recently has 6 registered licenses in different health care specialties including Behavioral Health & Social Service Providers / Counselor, Behavioral Health & Social Service Providers / Addiction (Substance Use Disorder), Behavioral Health & Social Service Providers / Mental Health, Behavioral Health & Social Service Providers / Pastoral, Behavioral Health & Social Service Providers / Professional, Behavioral Health & Social Service Providers / Marriage & Family Therapist. Behavioral Health & Social Service Providers / Mental Health is the primary health care specialty. Lisa Wallace can be contacted via phone (708) 462-4235, or through Wallace, Lisa via phone (708) 906-0205.

Contact Information

Primary practice address
20200 Governors Dr 107 Olympia Fields IL 60461-1032
Phone: (708) 462-4235
Fax:
Website:
Map and Directions
Authorized official contact:
Name: Wallace, Lisa LCPC
Phone: (708) 906-0205

Health care specialties

SpecialtyCodeLicense #State
Behavioral Health & Social Service Providers / Counselor 101Y00000X 180.008731 Illinois
Behavioral Health & Social Service Providers / Addiction (Substance Use Disorder) 101YA0400X 180.008731 Illinois
Behavioral Health & Social Service Providers / Mental Health 101YM0800X 180.008731 Illinois
Behavioral Health & Social Service Providers / Pastoral 101YP1600X 180.008731 Illinois
Behavioral Health & Social Service Providers / Professional 101YP2500X 180.008731 Illinois
Behavioral Health & Social Service Providers / Marriage & Family Therapist 106H00000X 180.008731 Illinois

Profile Details

NPI number 1427463405
LBN Legal business name Lisa Wallace
DBA Doing business as
Authorized official Wallace, Lisa LCPC
Entity Organization
Organization subpart 1 No
Enumeration date Jun 27th, 2014
Last updated Jun 27th, 2014 - about 11 years ago

1 Some organizations, which are providing health care services, may consist of units or departments that provide different types of health care services or have several separate physical locations, where health care service is provided. These units, departments or physical locations are not themselves legal entities. However, each of them is part of the organization, which is a legal entity. The organization may decide whether its subparts, if it has any, should have their own NPI numbers. In case a subpart conducts any HIPAA standard transactions by itself, without its parent's involvement, it must have its own NPI number.

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