IndividualActive
Jilba Wallace, MA LPC
NPI 1982611679 · Professional Counselor · Frederick, CO
Provider details
- NPI number
- 1982611679
- Entity type
- Individual
- Primary specialty
- Professional CounselorBehavioral Health & Social Service Providers
- Credential
- MA LPC
- Sex
- Female
- Sole proprietor
- Yes
- License
- 1242 (CO)
Specialties & taxonomies
Behavioral Health & Social Service Providers
Practice location
541 Oak Street
Ste 2
Frederick, CO 80530
Phone: (303) 588-6017
Approximate (ZIP-level) locationGet directions
Mailing address
Po Box 908
Frederick, CO 80530-0908
Registry dates
- Enumerated
- 2006-08-02
- Last updated
- 2007-07-08
Source: CMS NPPES Data Dissemination (June 2026). NPI Central is not affiliated with CMS. Data is provided as-is from the public registry.