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

Dedra Wallace

Individual provider Professional Counselor · NPI 1063810877

Dedra Wallace is a Mental Health Counselor in Pueblo, Colorado. Qualified in 2014, 12 years ago. Practices with Health Solutions, a 41-clinician group and accepts Medicare assignment. Licensed in Colorado.

Years since qualifying
12
Licensed in
CO
In the registry since
2014
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Practice location Address checks out

1302 Chinook Ln
Pueblo, CO 81001-1851
Phone: (719) 545-2746
Fax: (719) 545-4100
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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 LPC.0013214 (CO)

Record details

NPI number1063810877
Entity typeIndividual (Type 1)
GenderFemale
Sole proprietorNo
NPI enumeratedDecember 10, 2014
Last updated in NPPESOctober 19, 2016
Mailing address41 Montebello Road, Suite 200, Pueblo, CO 81004-1128

Medicare enrollment

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

Medicare specialtyMENTAL HEALTH COUNSELOR
Medical schoolOTHER
Graduated 2014 (12 years in practice)
Group practice Health Solutions — 41 clinicians
Accepts Medicare assignment Yes — accepts the Medicare-approved amount

Other providers in Pueblo