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

Ty Lamar Wallace, MSW

Individual provider Clinical Social Worker · NPI 1295257624

Ty Lamar Wallace, MSW is a Clinical Social Worker in Pinckneyville, Illinois. Practices as a sole proprietor. Licensed in Illinois.

Licensed in
IL
In the registry since
2017
What do these letters mean?
MSW — Master of Social Work
The graduate degree in social work.

See every abbreviation used in this directory →

Practice location Address checks out

4904 Bowls Bottom Rd
Pinckneyville, IL 62274-2453
Phone: (618) 926-6050
Show map & directions

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

Specialties & licences

Clinical Social Worker (primary) Taxonomy 1041C0700X · Licence 149-010121 (IL)

Record details

NPI number1295257624
Entity typeIndividual (Type 1)
GenderMale
Credentials MSW
Sole proprietorYes
NPI enumeratedJuly 7, 2017
Last updated in NPPESJuly 21, 2022
Mailing address4904 Bowls Bottom Rd, Pinckneyville, IL 62274-2453

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