Angela K Wallace, MFT

Primary specialty

Marriage & Family TherapistTaxonomy code 106H00000X

License

45450 Issued in CA

Legal business name

ANGELA K WALLACE, MFT

Practice address

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

Phone

(323) 270-5437

NPI assigned

Feb 19, 2015

Organization subpart

No

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

Authorized official

Name

Ms. Angela K Wallace, LMFT

Title

Psychotherapist

Phone

(323) 270-5437

Specialties & licenses 1

Addresses

Locations

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

{
    "created_epoch": "1424304000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1424304000000",
    "number": "1629460274",
    "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": "323-270-5437"
        },
        {
            "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": "323-270-5437"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ANGELA K WALLACE, MFT",
        "organizational_subpart": "NO",
        "enumeration_date": "2015-02-19",
        "last_updated": "2015-02-19",
        "status": "A",
        "authorized_official_last_name": "WALLACE",
        "authorized_official_first_name": "ANGELA",
        "authorized_official_middle_name": "K",
        "authorized_official_title_or_position": "PSYCHOTHERAPIST",
        "authorized_official_telephone_number": "323-270-5437",
        "authorized_official_name_prefix": "Ms.",
        "authorized_official_credential": "LMFT"
    },
    "taxonomies": [
        {
            "code": "106H00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Marriage & Family Therapist",
            "state": "CA",
            "license": "45450",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• 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 Feb 19, 2015; 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.