Individual ProviderRaychelle Sheryl WallaceCounselorBehavioral Health & Social Service ProvidersPractice Address673 W Lumsden Rd, Brandon, FL 33511-5911(813) 798-0800PECOS EnrollmentBased on the most recent information from CMS, provider Raychelle Sheryl Wallace does not have current enrollment records in PECOS.Part BMedicare Part BNot EnrolledHHAHome Health AgencyNot EnrolledDMEDurable Medical EquipmentNot EnrolledPMDPower Mobility DeviceNot EnrolledCMS last updated its PECOS records today at 11:06 AM.Profile DetailsProvider ID1609464098Provider TypeIndividualFull NameWallace, Raychelle SherylGenderFemaleSole ProprietorYesEnumeration Date1/2/2021Last Updated8/14/2023Contact InformationPractice LocationPractice Address673 W Lumsden Rd, Brandon, FL 33511-5911Phone(813) 798-0800Fax(813) 798-7800Mailing LocationMailing Address11705 Boyette Rd, Pmb 430, Riverview, FL 33569Phone(813) 798-0800FaxUnlisted FaxProvider TaxonomiesCodeDescriptionLicenseCode101YM0800XPrimaryDescriptionCounselorBehavioral Health & Social Service ProvidersLicenseMH19813FloridaCode251S00000XDescriptionCommunity/Behavioral HealthAgenciesLicenseIMH18337FloridaCode261QM0801XDescriptionClinic/CenterAmbulatory Health Care FacilitiesLicenseIMH18337FloridaCode251B00000XDescriptionCase ManagementAgenciesLicenseIMH18337FloridaCode261QM0850XDescriptionClinic/CenterAmbulatory Health Care FacilitiesLicenseIMH18337FloridaCode261QM0855XDescriptionClinic/CenterAmbulatory Health Care FacilitiesLicenseIMH18337Florida