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

Jacob Wallace

Individual provider Mental Health Counselor · NPI 1639031503

Jacob Wallace is a Mental Health Counselor in Palmetto Bay, Florida. Registered with an NPI since 2025.

In the registry since
2025

Practice location Address checks out

15924 SW 92nd Ave
Palmetto Bay, FL 33157-1842
Phone: (305) 964-5824
Show map & directions

Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Mental Health Counselor (primary) Taxonomy 101YM0800X

Record details

NPI number1639031503
Entity typeIndividual (Type 1)
GenderMale
Sole proprietorNo
NPI enumeratedDecember 1, 2025
Last updated in NPPESDecember 1, 2025
Certification dateDecember 1, 2025
Mailing address15175 Sw 111th St, Miami, FL 33196-2503

Other providers in Palmetto Bay