Independent US Healthcare Provider Directory & Public Medical Database
Active NPI 1174158976 Individual Practitioner Female Practitioner

Jennifer Dawn Wallace , LPCC, S

Counselor - Professional • Georgetown, KY

Professional Overview & Biography Verified Profile Summary

Jennifer Wallace, LPCC, S is a registered healthcare professional specializing in Counselor - Professional in Georgetown, KY. Practice services are available at 204 BEVINS LN STE A under active NPI credentials.

Practice Location & Contact Primary Location

Practice Address

204 Bevins Ln Ste A

Georgetown, KY 403246145

Telephone 8599519777
Fax 8599519779
Associated Practice Facility / Clinic
🏢 Lesa Young Counseling, Llc Facility NPI 1750854170

Specialty Benchmarks & Practice Insights

Comparative analytics for Counselor - Professional in Georgetown, KY

Active Practitioner
Practitioner Clinical Experience
Active
City Avg: 11.7 Yrs
State Avg: 13.2 Yrs
Regional Practice Density
25 Specialists

Practicing in Georgetown, KY (2199 Statewide)

Telehealth Adoption Rate
8.0% Regional Adoption

In-Person Office Visits Only

Medicare Pricing Discount
67.4% Avg Savings

Under CMS Medicare Fee Schedule vs Standard Submitted Charges

Medical Specialties & State Licenses

CMS Verified: 2020-11-20
Counselor - Professional Primary Specialty

NUCC Taxonomy Code: 101YP2500X

State License None 104157

Definition to come...

Counselor

NUCC Taxonomy Code: 101Y00000X

State License KY 104157

A provider who is trained and educated in the performance of behavior health services through interpersonal communications and analysis. Training and education at the specialty level usually requires a master's degree and clinical experience and supervision for licensure or certification.

Secondary Practice Locations

200 Bevins Ln Ste E

Georgetown, KY 403248532

Phone: 8599519777

Practice Associates & Co-Workers

Healthcare professionals and specialists practicing at this location or sharing practice phone/fax

5 Associated Practitioners
Caleb Mackey , LPCC

Counselor - Professional

NPI 1013741271

Licensed Professional Clinical Counselor

Jeffrey Chapman , LCSW

Social Worker - Clinical

NPI 1316685480

Licensed Clinical Social Worker

Lauren Polly , LCSW

Social Worker

NPI 1427702554

Licensed Clinical Social Worker

Alison Winger , LPCC

Counselor - Mental Health

NPI 1538724174

Licensed Professional Clinical Counselor

Lesa Young , LPCC

Counselor - Mental Health

NPI 1821537002

Licensed Professional Clinical Counselor

Career & Practice History Timeline

Chronological log of verified NPI updates, location relocations, credentials, and registry changes

11 Historical Events
📍
Updated Business Mailing Address November 20, 2020

Registered at 204 BEVINS LN STE A, GEORGETOWN, KY 403246145 (Tel: 8599519777)

🎓
Medical Taxonomy / Specialty Registered (Primary Specialty) November 20, 2020

Counselor (License #104157 in KY)

📍
Updated Practice Location June 22, 2020

Registered at 204 BEVINS LN STE A, GEORGETOWN, KY 403246145 (Tel: 8599519777)

👤
Provider Name / Credentials Updated June 22, 2020

Recorded as JENNIFER WALLACE, LPCC/S

🎓
Medical Taxonomy / Specialty Registered (Primary Specialty) June 22, 2020

Counselor (License #104157 in None)

NPI Profile Active March 12, 2020

NPI status registered as active in NPPES database

📍
Updated Practice Location March 12, 2020

Registered at 200 BEVINS LN STE E, GEORGETOWN, KY 403248532 (Tel: 8599519777)

📍
Updated Business Mailing Address March 12, 2020

Registered at 229 COLONY BLVD, GEORGETOWN, KY 403242507 (Tel: 5028671855)

👤
Provider Name / Credentials Updated March 12, 2020

Recorded as JENNIFER WALLACE, LPCC-S

🎓
Medical Taxonomy / Specialty Registered (Primary Specialty) March 12, 2020

Counselor (License #104157 in KY)

🟢
Initial NPI Registration & Enumeration March 12, 2020

First registered as active Individual Practitioner in NPPES Database.

Patient & Community Reviews

Verified patient ratings, medical care experiences, and facility photos

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NPI Administrative Meta

NPI Number: 1174158976
Entity Type:
Individual Provider Physician, Nurse Practitioner, or Solo Healthcare Professional (Type 1 NPI)
Enumeration Date: March 12, 2020
Last Update: November 20, 2020
Sole Proprietor: No

Mailing Address

204 Bevins Ln Ste A

Georgetown, KY 403246145

Phone: 8599519777

Public Domain Record This profile contains public domain information published by CMS and NPPES under the Freedom of Information Act (FOIA).
⚠️ Medical Disclaimer

This directory listing is for informational purposes only and does not constitute medical advice, diagnosis, or physician endorsement. If you are experiencing a medical emergency, please call 911 immediately.