Wallace Andrews LLC

Primary specialty

Behavior TechnicianTaxonomy code 106S00000X

Legal business name

WALLACE ANDREWS LLC

Practice address

1121 W Bell Rd Ste 373
Phoenix, AZ 85023-3516

Phone

(480) 925-1393

NPI assigned

Jun 28, 2023

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Mr. Wallace Clyde Andrews III, BEHAVIORAL HEALTH

Title

BHT/Facilitator/Wellness Coach

Phone

(480) 925-1393

Specialties & licenses 6

Addresses

Other names 1

• WALLACE ANDREWS Doing business as

Locations

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1687910400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1687996800000",
    "number": "1124705587",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1453 N DYSART RD STE 322",
            "city": "AVONDALE",
            "state": "AZ",
            "postal_code": "853231539",
            "telephone_number": "480-925-1393"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1121 W BELL RD STE 373",
            "city": "PHOENIX",
            "state": "AZ",
            "postal_code": "850233516",
            "telephone_number": "480-925-1393"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "10763 W Mountain View Dr",
            "address_purpose": "LOCATION",
            "city": "Avondale",
            "state": "AZ",
            "postal_code": "853231155",
            "country_code": "US",
            "telephone_number": "310-779-8804",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "6107 E Encanto St",
            "address_purpose": "LOCATION",
            "city": "Mesa",
            "state": "AZ",
            "postal_code": "852055956",
            "country_code": "US",
            "telephone_number": "310-779-8804",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "719 E Pepper Pl",
            "address_purpose": "LOCATION",
            "city": "Mesa",
            "state": "AZ",
            "postal_code": "852038747",
            "country_code": "US",
            "telephone_number": "480-925-1393",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "WALLACE ANDREWS LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2023-06-28",
        "last_updated": "2023-06-29",
        "certification_date": "2023-06-29",
        "status": "A",
        "authorized_official_last_name": "ANDREWS",
        "authorized_official_first_name": "WALLACE",
        "authorized_official_middle_name": "CLYDE",
        "authorized_official_title_or_position": "BHT/FACILITATOR/WELLNESS COACH",
        "authorized_official_telephone_number": "480-925-1393",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_name_suffix": "III",
        "authorized_official_credential": "BEHAVIORAL HEALTH"
    },
    "taxonomies": [
        {
            "code": "102X00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Poetry Therapist",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "106S00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Behavior Technician",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "171400000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Health & Wellness Coach",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "225800000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Recreation Therapist",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "253Z00000X",
            "taxonomy_group": "",
            "desc": "In Home Supportive Care",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "282J00000X",
            "taxonomy_group": "",
            "desc": "Religious Nonmedical Health Care Institution",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "WALLACE ANDREWS",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "WALLACE ANDREWS",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Richard A Wall, M.D.
• Sophia Wall, DMD
• Sterling Wall, DDS
• Tracy Wall
• Victoria M Wall
• Annisha Wallace, LCSW
• Blake Taylor Wallace, DPM
• Cheryl Wallace, RDH
• Christopher Scott Wallace, LCSW
• David Warner Wallace, MD

• Behavior Technician in Phoenix, AZ
• Providers in Phoenix, AZ by specialty
• Behavior Technician in Arizona

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 29, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.