Elizabeth Rachel Wallace, MFT

Primary specialty

Marriage & Family TherapistTaxonomy code 106H00000X

License

MG61524353 Issued in WA

Practice address

6505 216TH St SW Ste 100
Mountlake Terrace, WA 98043-2089

Phone

(425) 640-7009

Fax

(425) 678-6455

NPI assigned

Apr 26, 2021

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 2

Addresses

Other names 1

• Ms. Elizabeth Wallace Former name

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

Locations

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.

• Carenow Services, LLC

  • Community/Behavioral Health Agency
  • Roswell, GA
  • NPI 1770713117
  NPD

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

{
    "created_epoch": "1619395200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1720656000000",
    "number": "1649852906",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "100 N HOWARD ST STE W",
            "city": "SPOKANE",
            "state": "WA",
            "postal_code": "992010508",
            "telephone_number": "478-997-2363"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6505 216TH ST SW STE 100",
            "city": "MOUNTLAKE TERRACE",
            "state": "WA",
            "postal_code": "980432089",
            "telephone_number": "425-640-7009",
            "fax_number": "425-678-6455"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "401 Bombay Ln",
            "address_purpose": "LOCATION",
            "city": "Roswell",
            "state": "GA",
            "postal_code": "300765826",
            "country_code": "US",
            "telephone_number": "770-664-1920",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "WALLACE",
        "first_name": "ELIZABETH",
        "middle_name": "RACHEL",
        "name_prefix": "Prof.",
        "credential": "MFT",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2021-04-26",
        "last_updated": "2024-07-11",
        "certification_date": "2024-07-11",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "106H00000X",
            "taxonomy_group": "",
            "desc": "Marriage & Family Therapist",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "106H00000X",
            "taxonomy_group": "",
            "desc": "Marriage & Family Therapist",
            "state": "WA",
            "license": "MG61524353",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "ELIZABETH",
            "last_name": "WALLACE",
            "prefix": "MS.",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Celia Elizabeth Viveros, LICSW
• Kristina Yvonne Vrooman, CB61025277
• Darlene Grace Wagler, LMHCA
• Alexis Michael Walker
• Grant Walker, PHARM.D.
• Jamie Wallace
• Melissa Cecilia Walsh, MD
• Susan J.S. Walters, MD
• Jamie Wang, DPT
• Roy Wang

• Marriage & Family Therapist in Mountlake Terrace, WA
• Providers in Mountlake Terrace, WA by specialty
• Marriage & Family Therapist in Washington

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 11, 2024; 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.