Active NPI
Brenetta N. Wallace
- Clinical Social Worker
- Frisco, TX
National Provider Identifier
1720332646
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Social Worker
- License
- 65193
- Practice address
- 2770 Main St Ste 229
Frisco, TX 75033-4459 - Phone
- (714) 797-6015
- NPI assigned
- Oct 30, 2012
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Clinical Social Worker | 1041C0700X | 65193 | TX | Primary |
Addresses
Primary practice location
2770 Main St Ste 229
Frisco, TX 75033-4459
Mailing address
PO Box 120692
Arlington, TX 76012-0692
Phone (714) 797-6015
Other practice location 1
18302 Irvine Blvd Ste 300
Tustin, CA 92780-3437
Phone (714) 979-2365
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
| License | State | Type | Specialty |
|---|---|---|---|
| 65193 | TX | MD | Pharmacist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1351555200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1610409600000",
"number": "1720332646",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 120692",
"city": "ARLINGTON",
"state": "TX",
"postal_code": "760120692",
"telephone_number": "714-797-6015"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2770 MAIN ST STE 229",
"city": "FRISCO",
"state": "TX",
"postal_code": "750334459",
"telephone_number": "714-797-6015"
}
],
"practiceLocations": [
{
"address_1": "18302 Irvine Blvd Ste 300",
"address_purpose": "LOCATION",
"city": "Tustin",
"state": "CA",
"postal_code": "927803437",
"country_code": "US",
"telephone_number": "714-979-2365",
"country_name": "United States",
"address_type": "DOM"
}
],
"basic": {
"last_name": "WALLACE",
"first_name": "BRENETTA",
"middle_name": "N.",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2012-10-30",
"last_updated": "2021-01-12",
"certification_date": "2021-01-11",
"status": "A"
},
"taxonomies": [
{
"code": "1041C0700X",
"taxonomy_group": "",
"desc": "Social Worker, Clinical",
"state": "TX",
"license": "65193",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Frisco, TX
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 12, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.