Susan Victoria Wallace, CLINICIAN

Primary specialty

Marriage & Family TherapistTaxonomy code 106H00000X

License

MFC45089 Issued in CA

Practice address

3576 Arlington Ave Ste 106
Riverside, CA 92506-3907

Phone

(951) 788-5905

NPI assigned

May 22, 2012

Sex

Female

Sole proprietor

No

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 and National Provider Directory roles.

• Walden Environment

  • Community/Behavioral Health Agency
  • San Bernardino, CA
  • NPI 1225351828
  NPD (past)

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

{
    "created_epoch": "1337644800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1646092800000",
    "number": "1710247812",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "9685 HAYES ST",
            "city": "RIVERSIDE",
            "state": "CA",
            "postal_code": "925033660",
            "telephone_number": "951-351-4418"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3576 ARLINGTON AVE STE 106",
            "city": "RIVERSIDE",
            "state": "CA",
            "postal_code": "925063907",
            "telephone_number": "951-788-5905"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "255 N D St Ste 412",
            "address_purpose": "LOCATION",
            "city": "San Bernardino",
            "state": "CA",
            "postal_code": "924011715",
            "country_code": "US",
            "telephone_number": "951-788-5905",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "WALLACE",
        "first_name": "SUSAN",
        "middle_name": "VICTORIA",
        "name_prefix": "Mrs.",
        "credential": "CLINICIAN",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2012-05-22",
        "last_updated": "2022-03-01",
        "certification_date": "2022-03-01",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "106H00000X",
            "taxonomy_group": "",
            "desc": "Marriage & Family Therapist",
            "state": "CA",
            "license": "MFC45089",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Lindsey Walker
• Michael Claude Walker, PSY.D
• Victoria Walker
• Wetonna Marie Walker
• Megan Wallace, M.S., C.C.C-SLP
• Tammi Wallace
• Chris Eric Waller
• Andrew Michael Wallin
• Ken Carlson Walls, PHD, MPAS, DO
• Britt E Wallstrom, OT

• Marriage & Family Therapist in Riverside, CA
• Providers in Riverside, 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 1, 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.