NPIMap

Individual provider Active NPI

Joe Mac Pollock Jr., AMFT

  • Marriage & Family Therapist
  • Riverside, CA
National Provider Identifier
1427519941
Registry record updated Jan 6, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Marriage & Family TherapistTaxonomy code 106H00000X
License
108787 Issued in CA
Practice address
4164 Brockton Ave
Riverside, CA 92501-3400
Phone
(951) 683-5193
NPI assigned
Mar 27, 2019
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jan 6, 2022

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Mental Health Counselor 101YM0800X
Marriage & Family Therapist 106H00000X 108787 CA Primary

Addresses

Primary practice location

4164 Brockton Ave
Riverside, CA 92501-3400

Mailing address

4164 Brockton Ave
Riverside, CA 92501-3400
Phone (951) 683-5193

Other names 1

  • Mr. Joe Mac Pollock Jr. Professional name

Electronic endpoints 1

TypeEndpointUseAffiliation
Other URL www.carolynwylie.org

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

LicenseStateTypeSpecialty
108787CAMDMarriage & Family Therapist

Practice roles

OrganizationSpecialtyStatusNew patients
Chances Counseling Centers LLC Past Accepting new patients
Chances Counseling Center Mental Health Past Accepting new patients

Organizations & group practices 2

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.

NPI Registry JSON

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

{
    "created_epoch": "1553644800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1641427200000",
    "number": "1427519941",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4164 BROCKTON AVE",
            "city": "RIVERSIDE",
            "state": "CA",
            "postal_code": "925013400",
            "telephone_number": "951-683-5193"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4164 BROCKTON AVE",
            "city": "RIVERSIDE",
            "state": "CA",
            "postal_code": "925013400",
            "telephone_number": "951-683-5193"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "POLLOCK",
        "first_name": "JOE",
        "middle_name": "MAC",
        "name_prefix": "Mr.",
        "name_suffix": "Jr.",
        "credential": "AMFT",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2019-03-27",
        "last_updated": "2022-01-06",
        "certification_date": "2022-01-06",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YM0800X",
            "taxonomy_group": "",
            "desc": "Counselor, Mental Health",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "106H00000X",
            "taxonomy_group": "",
            "desc": "Marriage & Family Therapist",
            "state": "CA",
            "license": "108787",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "OTHERS",
            "endpointTypeDescription": "Other URL",
            "endpoint": "www.carolynwylie.org",
            "affiliation": "N",
            "address_1": "4164 Brockton Ave",
            "city": "Riverside",
            "state": "CA",
            "country_code": "US",
            "postal_code": "925013400",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": [
        {
            "first_name": "JOE",
            "last_name": "POLLOCK",
            "middle_name": "MAC",
            "prefix": "MR.",
            "suffix": "JR.",
            "credential": "JOE M POLLOCK JR",
            "code": "2",
            "type": "Professional Name"
        }
    ]
}

Other providers in Riverside, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 6, 2022; 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.