Bobby Wallace, B.A.

Primary specialty

Behavior TechnicianTaxonomy code 106S00000X

Practice address

3221 Behrman PL
New Orleans, LA 70114-8200

Phone

(504) 263-2800

NPI assigned

Feb 22, 2017

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other identifiers 1

Other names 1

• Bobby Wallace Professional name

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Credentials

Bachelor of Arts

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Divine Intervention Rehabilitation, LLC

  • Mental Health Clinic/Center (Including Community Mental Health Center)
  • New Orleans, LA
  • NPI 1346524378
  NPD (past)

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

{
    "created_epoch": "1487721600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1487721600000",
    "number": "1346789443",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3221 BEHRMAN PL",
            "city": "NEW ORLEANS",
            "state": "LA",
            "postal_code": "701148200",
            "telephone_number": "504-263-2800"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3221 BEHRMAN PL",
            "city": "NEW ORLEANS",
            "state": "LA",
            "postal_code": "701148200",
            "telephone_number": "504-263-2800"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WALLACE",
        "first_name": "BOBBY",
        "credential": "B.A.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2017-02-22",
        "last_updated": "2017-02-22",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "106S00000X",
            "taxonomy_group": "",
            "desc": "Behavior Technician",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1346524378",
            "state": "LA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "BOBBY",
            "last_name": "WALLACE",
            "credential": "B.A.",
            "code": "2",
            "type": "Professional Name"
        }
    ]
}

• William Walker Sr., MSW., RSW
• William Steven Walker, PH. D.
• Ellen Wall
• Luke Allen Wall, M.D.
• Billy Micheal Wallace III
• Brandy S Wallace
• Jetavia Wallace
• Leslie Austin Wallace, MSW, LCSW
• Brittany Jill Wallen, PHARM.D.
• John Brent Wallis, MD

• Behavior Technician in New Orleans, LA
• Providers in New Orleans, LA by specialty
• Behavior Technician in Louisiana

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 22, 2017; 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.