NICOLE BROADWAY WALLACE (NPI# 1821311606) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1821311606 |
| Entity Type | Individual |
| Full Name | NICOLE BROADWAY WALLACE |
| Other Name | NICOLE JANE BROADWAY |
| Credential | LPC |
| Practice Address |
207 Belo Dr Killeen TX 76542-5598 |
| Mailing Address |
2201 S. Ws Young Dr Suite 106-c Office 105 Killeen TX 76543 |
| Practice Telephone | 2546307450 |
| Practice Fax Number | 2548534241 |
| Mailing Telephone | 2546307450 |
| Mailing Fax Number | 2548534241 |
| Enumeration Date | 2010-03-08 |
| Last Update Date | 2013-09-16 |
| Gender Code | F |
| Is Sole Proprietor | Y |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 101YP2500X |
Counselor Specialization: Professional |
19501 | TX | Behavioral Health & Social Service Providers |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1275821993 | Nicole M. Wallace | Social Worker | 177 Main St Ste 206, Huntington, NY 11743-6917 | 2011-07-15 |
| 1366735839 | Nicole Mani Wallace | Chiropractor | 219 Main St Ste A, Pineville, NC 28134-7528 | 2011-05-17 |
| 1154820868 | Nicole Janeen Wallace | Counselor | 174 Mine Lake Ct Ste 200, Raleigh, NC 27615-6417 | 2018-02-08 |
| 1588964787 | Nicole Wallace | Physical Therapist | 3350 La Jolla Village Drive, San Diego, CA 92161 | 2010-10-22 |
| 1609089028 | Nicole Marie Wallace | Specialist | 913 First Colonial Rd Ste 204, Virginia Beach, VA 23454-3198 | 2007-05-08 |
| 1508889254 | Nicole Wallace | Physician Assistant | 1324 Lakeland Hills Blvd, Lakeland, FL 33805-4543 | 2006-07-25 |
| Street Address |
207 BELO DR |
| City | KILLEEN |
| State | TX |
| Zip Code | 76542-5598 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1841839446 | Phuong Lan Carter | Counselor | 9312 Bowlfield Drive, Killeen, TX 76542 | 2019-12-30 |
| 1083252209 | Killeen Dental and Orthodontics Pllc | Dentist | 2620 Trimmier Rd, Killeen, TX 76542 | 2019-12-18 |
| 1750935391 | Leo Mora Therapy Services Pllc | Marriage & Family Therapist | 400 W. Jasper Dr. Ste. 100b, Killeen, TX 76542 | 2019-08-01 |
| 1730742305 | Angela Eads | Behavioral Analyst | 3106 S Ws Young Dr, Building A, Suite 104/105, Killen, TX 76542 | 2019-04-18 |
| 1801370572 | Keri Keller | Dentist | 507 W Stan Schlueter Loop Ste 400, Killeen, TX 76542 | 2018-09-19 |
| 1740787209 | Cynthia Waller | Speech-Language Pathologist | 4205 Old Florence Road, Killeen, TX 76542 | 2018-04-11 |
| 1275034597 | Killeen Modern Dentistry, PC | Dentist | 507 W Stan Schlueter Loop, Suite 104, Killeen, TX 76542 | 2018-02-22 |
| 1780182691 | Jennifer Monique Coleman | Counselor | 9706 Shimla Drive, Killeen, TX 76542 | 2018-01-25 |
| 1255870440 | Glori Sommerer | Counselor | 100 S Central Texas Expressway, # 208, Harker Heights, TX 76542 | 2017-02-21 |
| 1306382775 | Dana Michelle Kerekes | Massage Therapist | 5001 Teal Drive, Killeen, TX 76542 | 2017-01-10 |
| Find all providers in zip 76542 | ||||
| Taxonomy Code | 101YP2500X |
| Grouping | Behavioral Health & Social Service Providers |
| Classification | Counselor |
| Specialization | Professional |
| Definition to come... |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1942813811 | Michelle Denise Knight | Counselor | 2201 S W S Young Dr Ste 105c, Killeen, TX 76543-5350 | 2020-08-28 |
| 1134747975 | Harmony Grace Counseling Pllc | Counselor | 2904 E Stan Schlueter Loop # 74, Killeen, TX 76542-4813 | 2020-07-08 |
| 1407483829 | Rocky Young | Counselor | 4304 E Central Texas Expy, Killeen, TX 76543-7308 | 2020-03-25 |
| 1013540228 | At Your Pace Counseling, LLC | Counselor | 1711 E Central Texas Expy Ste 301, Killeen, TX 76541-9147 | 2020-02-16 |
| 1841839446 | Phuong Lan Carter | Counselor | 9312 Bowlfield Drive, Killeen, TX 76542 | 2019-12-30 |
| 1578109807 | Roshetta Lee Cason | Counselor | 3705 Flat Rock Mountain Dr, Killeen, TX 76549-6530 | 2019-11-21 |
| 1386287480 | Genna P Vivona | Counselor | 1711 E Central Tx Expy Ste 100a, Killeen, TX 76541-9145 | 2019-10-21 |
| 1386206985 | Munirah Aziza Tarver | Counselor | 1711 E Central Texas Expy Ste 300f, Killeen, TX 76541-9120 | 2019-07-03 |
| 1982177713 | Butterflies Prospering Wellness Co. | Counselor | 3300 E Central Texas Expy Ste 301, Killeen, TX 76543-5306 | 2019-01-04 |
| 1215426317 | Daniel E Helvetius Jr. | Counselor | 4105 Paintbrush Dr, Killeen, TX 76542-4603 | 2018-05-03 |
| Find all providers in KILLEEN | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.