GRACE WAKIM (NPI# 1760981732) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1760981732 |
| Entity Type | Individual |
| Full Name | GRACE WAKIM |
| Credential | PSYD |
| Practice Address |
3900 Lakeville Hwy Mob 2 Petaluma CA 94954-5968 |
| Mailing Address |
1160 N Dutton Ave Ste 230 Santa Rosa CA 95401-4658 |
| Practice Telephone | 7077653565 |
| Mailing Telephone | 7073033243 |
| Enumeration Date | 2018-02-06 |
| Last Update Date | 2019-04-22 |
| Gender Code | F |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 103T00000X | Psychologist | 29666 | CA | Behavioral Health & Social Service Providers |
| Street Address |
3900 LAKEVILLE HWY MOB 2 |
| City | PETALUMA |
| State | CA |
| Zip Code | 94954-5968 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1013919190 | Daniel G White | Family Medicine | 3900 Lakeville Hwy, Petaluma, CA 94954-5698 | 2005-08-10 |
| 1669089066 | Trinique Pham | Physical Therapist | 3900 Lakeville Hwy, Petaluma, CA 94954-5698 | 2020-09-29 |
| 1336673110 | Matthew Anderson | Pharmacist | 3900 Lakeville Hwy, Petaluma, CA 94954-5698 | 2017-04-18 |
| 1497289268 | Suzanne Aoyagi | Pharmacist | 3900 Lakeville Hwy, Petaluma, CA 94954-5698 | 2017-04-18 |
| 1972902971 | Tamar Segev | Obstetrics & Gynecology | 3900 Lakeville Hwy, Petaluma, CA 94954-5698 | 2014-08-15 |
| 1184960312 | Moe Metwalli | Pharmacist | 3900 Lakeville Hwy, Petaluma, CA 94954-5698 | 2012-12-16 |
| 1639351208 | Mary Dawn Burke | Physical Therapist | 3900 Lakeville Hwy, Petaluma, CA 94954-5698 | 2007-12-05 |
| 1144418120 | Lindsey Hibbard | Pediatrics | 3900 Lakeville Hwy, Petaluma, CA 94954-5698 | 2007-10-04 |
| 1174734404 | Valerie Kuskulis | Social Worker | 3900 Lakeville Hwy, Petaluma, CA 94954-5698 | 2007-05-25 |
| 1437291028 | Liana Yungay Lam | Optometrist | 3900 Lakeville Hwy, Petaluma, CA 94954-5698 | 2007-02-12 |
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| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1346883840 | Miguel Ibarra | Counselor | 5350 Old Redwood Highway, Petaluma, CA 94954 | 2019-10-28 |
| 1073169223 | Monica Renee Najera | Behavior Technician | 1670 Corporate Circle, Ste. 100, Petaluma, CA 94954 | 2019-08-14 |
| 1326607201 | Making Magic Happen - People Helping People, Inc. | Marriage & Family Therapist | 1318 Redwood Way, Suite 260, Petaluma, CA 94954 | 2019-06-13 |
| 1477019917 | Rubi Isela Cruz Mendoza I | Behavioral Analyst | 8 Round Walk Circle, Petaluma, CA 94954 | 2019-02-20 |
| 1932679511 | Karen Christianson | Behavior Technician | 1670 Corporate Circle Suite 100, Petaluma, CA 94954 | 2018-11-27 |
| 1669956967 | Alyssa Messer | Assistant Behavior Analyst | 1670 Corporate Cir, Petaluma, CA 94954 | 2018-09-21 |
| 1235620592 | Mallory Paige Mullikin | Nurse Practitioner | 141 Lynch Creek Trail, Ste C, Petaluma, CA 94954 | 2018-05-22 |
| 1457723710 | Lisabel Dolne | Counselor | 1360 N. Mcdowell Blvd.1a, Petaluma, CA 94954 | 2015-10-27 |
| 1083080717 | Pacific Restorative Center | Clinic/Center | 1456 Professional Drive, Suite 404, Petaluma, CA 94954 | 2015-08-17 |
| 1619354198 | Accu Quest Hearing Centers | Clinic/Center | 1456 Professional Dr., Suite 404, Petaluma, CA 94954 | 2015-05-04 |
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| Taxonomy Code | 103T00000X |
| Grouping | Behavioral Health & Social Service Providers |
| Classification | Psychologist |
| A psychologist is an individual who is licensed to practice psychology which is defined as the observation, description, evaluation, interpretation, and modification of human behavior by the application of psychological principles, methods, and procedures, for the purpose of preventing or eliminating symptomatic, maladaptive, or undesired behavior and of enhancing interpersonal relationships, work and life adjustment, personal effectiveness, behavioral health, and mental health. The practice of psychology includes, but is not limited to, psychological testing and the evaluation or assessment of personal characteristics, such as intelligence, personality, abilities, interests, aptitudes, and neuropsychological functioning; counseling, psychoanalysis, psychotherapy, hypnosis, biofeedback, and behavior analysis and therapy; diagnosis and treatment of mental and emotional disorder or disability, alcoholism and substance abuse, disorders of habit or conduct, as well as of the psychological aspects of physical illness, accident, injury, or disability; and psycheducational evaluation, therapy, remediation, and consultation. Psychological services may be rendered to individuals, families, groups and the public. |
| Notes: Source: American Psychological Association [1/1/2007: modified definition] |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1689138299 | Chanda Rankin | Psychologist | 7 4th St Ste 52, Petaluma, CA 94952-7410 | 2019-01-28 |
| 1891901914 | Anna Gray | Psychologist | 515 Greenbriar Cir, Petaluma, CA 94954-3538 | 2007-05-15 |
| 1568506319 | Barbara Finley Badham | Psychologist | 320 Western Ave, Petaluma, CA 94952 | 2007-02-16 |
| 1659418770 | Iverson M. Eicken | Psychologist | 720 Southpoint Blvd, Suite 202, Petaluma, CA 94954-7495 | 2007-01-30 |
| 1699861419 | Jennifer T. Seymour | Psychologist | 713 Mount Vernon Way, Petaluma, CA 94954-2511 | 2006-10-05 |
| 1558473538 | Hope Counseling Services | Psychologist | 941 B Street, Petaluma, CA 94952 | 2006-08-31 |
| 1053748632 | Natalie Conrad | Psychologist | 365 Kuck Ln, Petaluma, CA 94952-9606 | 2013-09-27 |
| 1437586021 | Craig Goishi | Psychologist | 365 Kuck Ln, Petaluma, CA 94952-9606 | 2013-09-27 |
| 1710151741 | Peter Trask Dunlap | Psychologist | 1 Bodega Ave, Suite 1, Petaluma, CA 94952-2666 | 2008-04-22 |
| 1205036357 | Jimmy Lee Matto-shepard | Psychologist | 1 Bodega Ave, Suite #4, Petaluma, CA 94952-2666 | 2007-07-18 |
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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.