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

Patrick John Wallace Jr.

Individual provider Mental Health Counselor · NPI 1811853112

Patrick John Wallace Jr. is a Mental Health Counselor in Maple Grove, Minnesota. Licensed in Minnesota. Registered with an NPI since 2025.

Licensed in
MN
In the registry since
2025

Practice location Address checks out

13603 80th Cir N
Maple Grove, MN 55369-8961
Phone: (763) 274-3120
Fax: (763) 274-3121
Show map & directions

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

Specialties & licences

Mental Health Counselor (primary) Taxonomy 101YM0800X (MN)

Record details

NPI number1811853112
Entity typeIndividual (Type 1)
GenderMale
Sole proprietorNo
NPI enumeratedDecember 30, 2025
Last updated in NPPESDecember 30, 2025
Certification dateDecember 30, 2025
Mailing address909 Gould Ave Ne Apt 329, Columbia Heights, MN 55421-4718

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