Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.
NPIDirectory

Angela Wallace, LPC

Individual provider Professional Counselor · NPI 1417435819

Angela Wallace, LPC is a Mental Health Counselor in Saint Louis, Missouri. Qualified in 2016, 10 years ago. Practices with Provident Inc, a 19-clinician group and accepts Medicare assignment. Licensed in Missouri.

Years since qualifying
10
Licensed in
MO
In the registry since
2018
What do these letters mean?
LPC — Licensed Professional Counselor
A licensed mental health counsellor.

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Practice location Address checks out

11166 Tesson Ferry Rd Ste 300
Saint Louis, MO 63123-6966
Phone: (314) 898-0102
Fax: (314) 842-2552
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Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Professional Counselor (primary) Taxonomy 101YP2500X · Licence 2016034902 (MO)

Record details

NPI number1417435819
Entity typeIndividual (Type 1)
GenderFemale
Credentials LPC
Sole proprietorNo
NPI enumeratedJuly 30, 2018
Last updated in NPPESNovember 2, 2023
Certification dateNovember 2, 2023

Medicare enrollment

From the CMS Doctors & Clinicians file — this clinician is enrolled in Medicare.

Medicare specialtyMENTAL HEALTH COUNSELOR
Medical schoolOTHER
Graduated 2016 (10 years in practice)
Group practice Provident Inc — 19 clinicians
Accepts Medicare assignment Yes — accepts the Medicare-approved amount

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