Active NPI
Melissa Marie Wallace
- Foster Care Agency
- Yuma, AZ
National Provider Identifier
1245124270
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Foster Care Agency
- License
- 780
- Practice address
- 2797 W 21St LN
Yuma, AZ 85364-6059 - Phone
- (928) 386-0844
- NPI assigned
- Jun 4, 2025
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Child Physical Disabilities Respite Care | 385HR2065X | 780 | AZ | |
| Foster Care Agency | 253J00000X | 780 | AZ | Primary |
Addresses
Primary practice location
2797 W 21St LN
Yuma, AZ 85364-6059
Mailing address
2797 W 21St LN
Yuma, AZ 85364-6059
Phone (928) 386-0844
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 |
|---|---|---|---|
| 780 | AZ | MD | Psychologist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1748995200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1748995200000",
"number": "1245124270",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2797 W 21ST LN",
"city": "YUMA",
"state": "AZ",
"postal_code": "853646059",
"telephone_number": "928-386-0844"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2797 W 21ST LN",
"city": "YUMA",
"state": "AZ",
"postal_code": "853646059",
"telephone_number": "928-386-0844"
}
],
"practiceLocations": [],
"basic": {
"last_name": "WALLACE",
"first_name": "MELISSA",
"middle_name": "MARIE",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2025-06-04",
"last_updated": "2025-06-04",
"certification_date": "2025-06-04",
"status": "A"
},
"taxonomies": [
{
"code": "385HR2065X",
"taxonomy_group": "",
"desc": "Respite Care, Respite Care, Physical Disabilities, Child",
"state": "AZ",
"license": "780",
"primary": false
},
{
"code": "253J00000X",
"taxonomy_group": "",
"desc": "Foster Care Agency",
"state": "AZ",
"license": "780",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Yuma, AZ
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 4, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.