Provider Demographics
NPI:1902040678
Name:WALLACE, DENISE EILEEN (LMHC)
Entity Type:Individual
Prefix:
First Name:DENISE
Middle Name:EILEEN
Last Name:WALLACE
Suffix:
Gender:F
Credentials:LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:600 1ST AVE
Mailing Address - Street 2:SUITE 531
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98104-2216
Mailing Address - Country:US
Mailing Address - Phone:720-987-9087
Mailing Address - Fax:
Practice Address - Street 1:600 1ST AVE
Practice Address - Street 2:SUITE 531
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98104-2216
Practice Address - Country:US
Practice Address - Phone:720-987-9087
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-04-26
Last Update Date:2009-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA601942238101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health