Individual provider · Type 1 NPI

Jacob Wallace

Mental Health Counselor · Palmetto Bay, FL

NPI number 1639031503 Active

Practice location

15924 SW 92nd Ave
Palmetto Bay, FL 33157-1842

Mailing address

15175 SW 111th St
Miami, FL 33196-2503

Specialties and licenses

TaxonomyCodeLicense
Mental Health Counselor Primary 101YM0800XNone listed

Mental Health Counselor: Definition to come...

153 other providers at this address

Other mental health counselor providers in Palmetto Bay

See all in Palmetto Bay →

About NPI 1639031503

Jacob Wallace's National Provider Identifier is 1639031503, issued on Dec 1, 2025. The primary taxonomy on file is Mental Health Counselor (101YM0800X), and the practice location is in Palmetto Bay, FL. The record was last updated on Dec 1, 2025.