JUSTIN MATTHEW WALLACE LMFT
NPI 1417331679
Marriage & Family Therapist in Fresno, CA
About Justin Matthew Wallace Lmft NPPES
Official registry information on file with the National Plan and Provider Enumeration System.
JUSTIN MATTHEW WALLACE LMFT (NPI 1417331679) is an individual marriage & family therapist in Fresno, California, licensed in California (LMFT95974) and active in the NPI registry since July 2015. He is enrolled in Medicare PECOS and is a graduate of Other (2013).
NPPES Registry Identity
Specialties & Licenses
Medicare Participation & PECOS CMS
Medicare enrollment, assignment, billing reassignment, and ordering and referring status from CMS.
Medicare Enrollment Status
Enrolled in Medicare and accepts Medicare assignment
Justin Matthew Wallace Lmft is registered in PECOS and agrees to accept the Medicare-approved amount as full payment. Medicare patients are not billed beyond the standard deductible and coinsurance.
Medicare Billing Reassignment
Medicare enrollment records show Justin Wallace reassigns Medicare billing to 1 organization. The organization bills Medicare for the services this provider delivers there.
Fresno, CA 93710
- Reassigned Medicare billing, California enrollment
- 17 clinicians in this Medicare group
Source: CMS Revalidation Reassignment List, October 2026 release. Reassignment records can lag staffing changes; confirm a current affiliation with the organization.
Other Providers at the Same Location NPPES 16
Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.
FRESNO, CA 93710
FRESNO, CA 93710
FRESNO, CA 93710
FRESNO, CA 93710
Frequently Asked Questions NPPES & CMS
Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.
What is Justin Wallace's NPI number?
The NPI number for Justin Wallace is 1417331679. It was assigned to this individual provider in the NPPES registry on July 16, 2015.
Where is Justin Wallace located?
Justin Wallace practices at 1322 E Shaw Ave Ste 410, Fresno, CA 93710. The listed phone number is (559) 226-1316.
What is Justin Wallace's specialty?
The primary specialty registered for this NPI is Marriage & Family Therapist with taxonomy code 106H00000X.
Is Justin Wallace enrolled in Medicare?
Yes. Justin Wallace is registered in the Medicare PECOS system and accepts Medicare assignment, which means accepting the Medicare-approved amount as payment in full for covered services.
Which organization bills Medicare for Justin Wallace's services?
According to the CMS Revalidation Reassignment List (October 2026 release), Justin Wallace reassigns Medicare benefits to House Psychiatric Clinic, Inc. (Fresno, CA). The reassignment is filed with Medicare on form CMS-855R, signed by both the clinician and the organization, and lets the organization bill Medicare and receive payment for Justin Wallace's services. Reassignment records can lag staffing changes; confirm current arrangements with the organization.
When was this NPI record last updated?
The NPPES record for Justin Wallace was last updated on September 5, 2024. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 2 years ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.
# Justin Matthew Wallace, LMFT · NPI 1417331679
Marriage & Family Therapist provider in Fresno, California. Individual provider, active in the CMS NPPES registry since July 16, 2015.
## Identity
- **NPI:** 1417331679 (Entity type: Individual)
- **Enumerated:** July 16, 2015
- **Primary specialty:** Marriage & Family Therapist · taxonomy 106H00000X
- **State license:** LMFT95974 (California)
- **Sole proprietor:** Yes
## Practice location
- **Address:** 1322 E SHAW AVE STE 410, Fresno, CA 93710-7904
- **Phone:** (559) 226-1316
## Medicare
- **Medicare:** Enrolled (PECOS); accepts Medicare assignment
- **Ordering & referring:** eligible for Part B labs & imaging, durable medical equipment
- **Bills Medicare through:** House Psychiatric Clinic, Inc. (NPI 1235314246, Fresno, CA), under Medicare reassignment (form CMS-855R) · CMS Revalidation Reassignment List, October 2026 release
- **Medical school:** Other, class of 2013
## Record status
- **NPPES last updated:** September 5, 2024
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Source: [NPI Profile](https://npiprofile.com/npi/1417331679) · Data from the CMS NPPES public registry.