JUSTIN MATTHEW WALLACE LMFT - NPI 1417331679 - Marriage & Family Therapist in Fresno, CA

Q: 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.

Q: What is Justin Wallace's specialty?

The primary specialty registered for this NPI is Marriage & Family Therapist with taxonomy code 106H00000X.

Q: 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 22 months 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.

On this page

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

NPI1417331679

Entity TypeIndividualMale

Primary Taxonomy106H00000X

Provider Legal NameJUSTIN MATTHEW WALLACECredential: LMFT

Location Address1322 E SHAW AVE STE 410Fresno, CA 93710-7904

Mailing Address1322 E Shaw Ave Ste 410Fresno, CA 93710-7904 · (559) 226-1316

Phone(559) 226-1316

Sole ProprietorYes

Medical School CMSOtherGraduated 2013

Enumeration DateJuly 16, 2015

Last NPPES UpdateSeptember 5, 20242 updates tracked since enumeration

NPPES CertifiedSeptember 5, 2024

✔ NPI 1417331679 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyMarriage & Family TherapistBehavioral Health & Social Service Providers

Taxonomy Code106H00000X

License✔ Licensed in CA · LMFT95974

Definition

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.

1322 E SHAW AVE STE 410, Fresno, CA 93710

Open in Google Maps ↗

Medicare Participation & PECOS CMS

Medicare enrollment, assignment, and ordering and referring status from the CMS PECOS system.

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.

PECOS PAC ID3072964089

PECOS Enrollment IDI20240103004061

Eligible to Order & Refer✔ Part B Labs & Imaging✔ Durable Medical Equipment– Home Health Agency– Power Mobility DevicesPer the CMS Ordering and Referring file. Eligibility means Medicare pays claims that this provider orders or refers for these categories.

Other Providers at the Same Location NPPES 15

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

MR. NOAH MICHAEL SARR FNP

Nurse Practitioner (Psychiatric/Mental Health)