JUSTIN MATTHEW WALLACE (NPI# 1417331679) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1417331679 |
| Entity Type | Individual |
| Full Name | JUSTIN MATTHEW WALLACE |
| Credential | LMFT |
| Practice Address |
1322 E Shaw Ave Ste 410 Fresno CA 93710-7904 |
| Practice Telephone | 5592261316 |
| Mailing Telephone | 5592261316 |
| Enumeration Date | 2015-07-16 |
| Last Update Date | 2016-11-10 |
| Gender Code | M |
| Is Sole Proprietor | Y |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 106H00000X | Marriage & Family Therapist | LMFT95974 | CA | Behavioral Health & Social Service Providers |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1649609728 | Justin K Wallace | Veterinarian | 120 S 6th St, Chickasha, OK 73018-3420 | 2013-11-08 |
| 1114354156 | Justin Cory Wallace | Military Health Care Provider | 699 14th St, San Diego, CA 92101-7586 | 2013-10-06 |
| 1578807103 | Justin Covey Wallace | Registered Nurse | 4212 N 16th St, Phoenix, AZ 85016-5319 | 2012-11-20 |
| 1033372594 | Justin Robert Wallace | Surgery | 530 South St, Suite 380, Greensburg, PA 15601-2775 | 2008-07-05 |
| Street Address |
1322 E SHAW AVE STE 410 |
| City | FRESNO |
| State | CA |
| Zip Code | 93710-7904 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1871598623 | Susan Davin | Nurse Practitioner | 1322 E Shaw Ave Ste 410, Fresno, CA 93710-7904 | 2005-06-17 |
| 1326669375 | Joan Joy | Marriage & Family Therapist | 1322 E Shaw Ave Ste 410, Fresno, CA 93710-7904 | 2020-04-30 |
| 1528539681 | Andrew Douglas Monasterio | Nurse Practitioner | 1322 E Shaw Ave Ste 410, Fresno, CA 93710-7904 | 2018-12-16 |
| 1518440361 | Donald Thomas Vercellini Jr. | Psychologist | 1322 E Shaw Ave Ste 410, Fresno, CA 93710-7904 | 2018-09-07 |
| 1518448521 | Sheng Yang | Nurse Practitioner | 1322 E Shaw Ave Ste 410, Fresno, CA 93710-7904 | 2018-08-27 |
| 1700330891 | Ming Morris | Nurse Practitioner | 1322 E Shaw Ave Ste 410, Fresno, CA 93710-7904 | 2016-08-07 |
| 1861739989 | Paul Hulak | Registered Nurse | 1322 E Shaw Ave Ste 410, Fresno, CA 93710-7904 | 2013-01-09 |
| 1184921199 | Nadia Yousef Orme | Marriage & Family Therapist | 1322 E Shaw Ave Ste 410, Fresno, CA 93710-7904 | 2011-02-28 |
| 1306156179 | Ani Tokat | Psychiatry & Neurology | 1322 E Shaw Ave Ste 410, Fresno, CA 93710-7904 | 2010-10-14 |
| 1629246202 | Randy James Callahan | Physician Assistant | 1322 E Shaw Ave Ste 410, Fresno, CA 93710-7904 | 2008-02-15 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1184240384 | Patsy Joan Perry | Counselor | Quality Family Services - Sample House, 643 E. Sample Avenue, Fresno, CA 93710 | 2020-06-23 |
| 1831739853 | Blanca Stephanie Millan | Counselor | 1300 E Shaw Ave Suite 172, Fresno, CA 93710 | 2020-01-07 |
| 1679115737 | Abel Luis Flores | Physical Therapy Assistant | 5556 N Fresno St, 5555 N Fresno St, Fresno, CA 93710 | 2019-10-10 |
| 1316408933 | Simranjit Kaur Mann | Behavioral Analyst | 5180 North Primitivo Way Appt #363, Fresno, CA 93710 | 2019-03-27 |
| 1093274169 | Aleajndra Bedolla Alcantar | Behavior Technician | 1320 East Shaw Ave, #110, Fresno, CA 93710 | 2019-03-18 |
| 1790244960 | Alondra Martinez | Behavior Technician | 1320 East Shaw Ave #110, Fresno, CA 93710 | 2019-03-18 |
| 1235698622 | Irma Joselyn Castro | Behavior Technician | 1320 East Shaw Ave # 110, Fresno, CA 93710 | 2019-03-15 |
| 1619433711 | Beacon Dental Group | Dentist | 6099 N. First Ste Ste 102, Fresno, CA 93710 | 2019-02-13 |
| 1265909394 | Pathana Phonesy | Behavior Technician | 5363 N. Fresno St., Suite 105, Fresno, CA 93710 | 2018-10-26 |
| 1376030080 | Jane F Kardashian Md Inc | Non-Pharmacy Dispensing Site | 6769 N Fresno, Fresno, CA 93710 | 2018-04-18 |
| Find all providers in zip 93710 | ||||
| Taxonomy Code | 106H00000X |
| Grouping | Behavioral Health & Social Service Providers |
| Classification | Marriage & Family Therapist |
| A marriage and family therapist is a person with a master's degree in marriage and family therapy, or a master's or doctoral degree in a related mental health field with substantially equivalent coursework in marriage and family therapy, who receives supervised clinical experience, or a person who meets the state requirements to practice as a marriage and family therapist. A marriage and family therapist treats mental and emotional disorders within the context of marriage and family systems. A marriage and family therapist provides mental health and counseling services to individuals, couples, families, and groups. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1215540141 | Nina Coffin | Marriage & Family Therapist | 5151 N Palm Ave Ste 720, Fresno, CA 93704-2221 | 2020-08-29 |
| 1205464468 | Anahi Arias Aranda | Marriage & Family Therapist | 3645 W Shaw Ave # 101, Fresno, CA 93711-3206 | 2020-03-31 |
| 1396396800 | Sarah Settle | Marriage & Family Therapist | 1744 E Nees Ave, Fresno, CA 93720-2301 | 2019-09-25 |
| 1285192096 | Antionette Brookins & Associates, Corp | Marriage & Family Therapist | 5275 N 1st St, Fresno, CA 93710-7007 | 2019-03-11 |
| 1285107771 | Timothy Childs | Marriage & Family Therapist | 4928 E Clinton Way #108, Fresno, CA 93727-1526 | 2019-01-07 |
| 1922578574 | Dalise N Smith | Marriage & Family Therapist | 6224 W Belmont Ave, Fresno, CA 93723-9556 | 2018-11-27 |
| 1265908560 | Diana Hernandez-zamarripa | Marriage & Family Therapist | 1350 Van Ness Ave, Fresno, CA 93721-1714 | 2018-10-15 |
| 1093296279 | Emma Shaljyan | Marriage & Family Therapist | 2025 E Dakota Ave Ste 200, Fresno, CA 93726-4804 | 2018-08-24 |
| 1063993756 | Destination.hope Counseling & Enrichment Center | Marriage & Family Therapist | 5756 N Marks Ave Ste 156, Fresno, CA 93711-2171 | 2018-08-22 |
| 1760970412 | Ariel A Floriano | Marriage & Family Therapist | 2002 N Fine Ave Ste 101, Fresno, CA 93727-1511 | 2018-04-27 |
| Find all providers in FRESNO | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.