John Robert Wallis, L.P.C.

Primary specialty

Mental Health CounselorTaxonomy code 101YM0800X

License

AA450 Issued in AK

Practice address

3901 E Bogard Rd
Wasilla, AK 99654-6068

Phone

(907) 376-0459

Fax

(907) 376-0493

NPI assigned

Nov 11, 2008

Last updated

Nov 11, 2008By the provider in NPPES

Sex

Male

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, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Alaska Family Services Inc.

  • Mental Health Clinic/Center (Including Community Mental Health Center)
  • Palmer, AK
  • NPI 1073701033
  NPD (past)

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

{
    "created_epoch": "1226361600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1226361600000",
    "number": "1851545396",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1825 S CHUGACH ST",
            "city": "PALMER",
            "state": "AK",
            "postal_code": "996456795",
            "telephone_number": "907-746-4080",
            "fax_number": "907-746-1177"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3901 E BOGARD RD",
            "city": "WASILLA",
            "state": "AK",
            "postal_code": "996546068",
            "telephone_number": "907-376-0459",
            "fax_number": "907-376-0493"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WALLIS",
        "first_name": "JOHN",
        "middle_name": "ROBERT",
        "credential": "L.P.C.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2008-11-11",
        "last_updated": "2008-11-11",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YM0800X",
            "taxonomy_group": "",
            "desc": "Counselor, Mental Health",
            "state": "AK",
            "license": "AA450",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Philip Wall, DC
• Dianna Lynn Wallace
• Tamara Wallace
• Amanda Marie Wallen
• John Ralph Wallingford Jr.
• Walmart Inc. (Walmart Pharmacy 10-2074)
• Walmart, Inc. (Walmart pharmacy 10-3164)
• Michael Walsh
• Walther Dental Inc
• Newell A Walther, D.D.S.

• Mental Health Counselor in Wasilla, AK
• Providers in Wasilla, AK by specialty
• Mental Health Counselor in Alaska

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 11, 2008; 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.