Angela Kathleen Wallace, MFT #45450

Primary specialty

Marriage & Family TherapistTaxonomy code 106H00000X

License

45450 Issued in CA

Practice address

554 S San Vicente Blvd Ste 200
Los Angeles, CA 90048-4651

Phone

(310) 862-4668

NPI assigned

Mar 28, 2018

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

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

{
    "created_epoch": "1522195200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1522195200000",
    "number": "1417452731",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "554 S SAN VICENTE BLVD STE 200",
            "city": "LOS ANGELES",
            "state": "CA",
            "postal_code": "900484651",
            "telephone_number": "310-862-4668"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "554 S SAN VICENTE BLVD STE 200",
            "city": "LOS ANGELES",
            "state": "CA",
            "postal_code": "900484651",
            "telephone_number": "310-862-4668"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WALLACE",
        "first_name": "ANGELA",
        "middle_name": "KATHLEEN",
        "credential": "MFT #45450",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2018-03-28",
        "last_updated": "2018-03-28",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "106H00000X",
            "taxonomy_group": "",
            "desc": "Marriage & Family Therapist",
            "state": "CA",
            "license": "45450",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "TYPE 2 NPI",
            "identifier": "1629460274",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Britney Wall, LVN
• Charlotte Wall
• Emma Wall, BMBCH
• Lucy Wall, PSYD
• Wallace Integrative Therapy a Marriage and Family Therapy Corporation
• Ashley Wallace
• Ayesha Wallace
• Caroline Sheridan Wallace, AMFT
• Cheyenne Wallace
• David Wallace

• Marriage & Family Therapist in Los Angeles, CA
• Providers in Los Angeles, CA by specialty
• Marriage & Family Therapist in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 28, 2018; 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.