Everett Wallace

Primary specialty

Addiction (Substance Use Disorder) CounselorTaxonomy code 101YA0400X

License

CI30830920 Issued in CA

Practice address

44374 Palm St
Indio, CA 92201-3117

Phone

(760) 342-6616

NPI assigned

Dec 29, 2020

Last updated

Dec 29, 2020By the provider in NPPES

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

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

• A.B.C. Recovery Center, Inc.

  dba ABC Recovery Center

  • Substance Abuse Rehabilitation Facility
  • Indio, CA
  • NPI 1881788503
  NPD (past)

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

{
    "created_epoch": "1609200000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1609200000000",
    "number": "1528655107",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1488 E RAMON RD APT 129",
            "city": "PALM SPRINGS",
            "state": "CA",
            "postal_code": "922640828",
            "telephone_number": "901-581-0817"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "44374 PALM ST",
            "city": "INDIO",
            "state": "CA",
            "postal_code": "922013117",
            "telephone_number": "760-342-6616"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WALLACE",
        "first_name": "EVERETT",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2020-12-29",
        "last_updated": "2020-12-29",
        "certification_date": "2020-12-29",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YA0400X",
            "taxonomy_group": "",
            "desc": "Counselor, Addiction (Substance Use Disorder)",
            "state": "CA",
            "license": "CI30830920",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Walgreen Co (Walgreens #10703)
• Walgreen Co (Walgreens #09080)
• Eleasha Walker
• Gregory Walker I
• Linda J Walker
• Walmart Inc. (Walmart Pharmacy 10-8958)
• Walmart Inc. (WalMart Pharmacy 10-2181)
• Sara Lynn Walpole, LMFT
• Bryan Keith Ward Jr.
• Jazmine Amber Ware, CNA

• Addiction (Substance Use Disorder) Counselor in Indio, CA
• Providers in Indio, CA by specialty
• Addiction (Substance Use Disorder) Counselor in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 29, 2020; 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.