Active NPI
Wallace Forslof
- Counselor
- Mill Creek, WA
National Provider Identifier
1083572887
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Counselor
- License
- MHCA.MC.70001246
- Practice address
- 16300 Mill Creek Blvd
Mill Creek, WA 98012-1737 - Phone
- (206) 618-0770
- NPI assigned
- Jan 12, 2026
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Counselor | 101Y00000X | MHCA.MC.70001246 | WA | Primary |
Addresses
Primary practice location
16300 Mill Creek Blvd
Mill Creek, WA 98012-1737
Mailing address
20318 36TH Ave NW
Stanwood, WA 98292-9018
Phone (206) 618-0770
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| MHCA.MC.70001246 | WA | MD | Counselor |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1768176000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1768176000000",
"number": "1083572887",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "20318 36TH AVE NW",
"city": "STANWOOD",
"state": "WA",
"postal_code": "982929018",
"telephone_number": "206-618-0770"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "16300 MILL CREEK BLVD",
"city": "MILL CREEK",
"state": "WA",
"postal_code": "980121737",
"telephone_number": "206-618-0770"
}
],
"practiceLocations": [],
"basic": {
"last_name": "FORSLOF",
"first_name": "WALLACE",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2026-01-12",
"last_updated": "2026-01-12",
"certification_date": "2026-01-12",
"status": "A"
},
"taxonomies": [
{
"code": "101Y00000X",
"taxonomy_group": "",
"desc": "Counselor",
"state": "WA",
"license": "MHCA.MC.70001246",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Mill Creek, WA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 12, 2026; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.