Dedra Wallace
NPI 1063810877 · Professional Counselor · Pueblo, CO
Enrolled with Medicare as Practitioner - Mental Health Counselor · source: CMS PECOS Public Provider Enrollment (2026.04.01)
Dedra Wallace is a Professional Counselor provider in Pueblo, CO (NPI 1063810877).
Provider details
- NPI number
- 1063810877
- Entity type
- Individual
- Primary specialty
- Professional CounselorBehavioral Health & Social Service Providers
- Sex
- Female
- Sole proprietor
- No
- License
- LPC.0013214 (CO)
Specialties & taxonomies
Behavioral Health & Social Service Providers
Profile Score
A profile completeness & documented-activity index — NOT a quality, outcomes, or patient-satisfaction rating.
- Registry tenure38% of score
11 yrs in NPPES registry
- Profile completeness38% of score
100% of core fields populated
- Practice footprint23% of score
1 documented practice location
Signals a provider has no public data for (e.g. Medicare claims) are left out of the score entirely — never counted as zero — so providers without that data are not penalized. See the full formula and weights in our methodology.
Practice location
Mailing address
Registry dates
- Enumerated
- 2014-12-10
- Last updated
- 2016-10-19
Frequently asked questions
- What is Dedra Wallace's NPI number?
- Dedra Wallace's National Provider Identifier (NPI) is 1063810877, a unique 10-digit ID issued by CMS for use in standard healthcare transactions.
- What is Dedra Wallace's specialty?
- Dedra Wallace is listed in the NPPES registry with a primary specialty of Professional Counselor (Behavioral Health & Social Service Providers).
- Where is Dedra Wallace located?
- Dedra Wallace's practice location on file with NPPES is 1302 Chinook Ln, Pueblo, CO 81001-1851.
- What is Dedra Wallace's phone number?
- The practice phone number listed in the NPPES registry for Dedra Wallace is (719) 545-2746.
- Does Dedra Wallace accept Medicare?
- Dedra Wallace is approved to bill Medicare according to CMS PECOS enrollment data (2026.04.01). Confirm current participation with the provider before scheduling.
- Is Dedra Wallace's NPI active?
- Yes — Dedra Wallace's NPI (1063810877) is active in the NPPES registry as of the last update on 2016-10-19.
Source: CMS NPPES Data Dissemination (June 2026). NPI Central is not affiliated with CMS. Data is provided as-is from the public registry.