Johnny Michael Wallace

Primary specialty

Behavior TechnicianTaxonomy code 106S00000X

Practice address

139 Hugo St Apt 3
San Francisco, CA 94122-2760

Phone

(310) 691-3644

NPI assigned

Apr 15, 2021

Sex

Male

Sole proprietor

Yes

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

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.

• Adapt: a Behavioral Collective, Inc.

  • Early Intervention Provider Agency
  • San Francisco, CA
  • NPI 1508226267
  NPD (past)

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

{
    "created_epoch": "1618444800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1618444800000",
    "number": "1861073413",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5940 EL ESCORPION RD",
            "city": "WOODLAND HILLS",
            "state": "CA",
            "postal_code": "913673923",
            "telephone_number": "818-620-6005"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "139 HUGO ST APT 3",
            "city": "SAN FRANCISCO",
            "state": "CA",
            "postal_code": "941222760",
            "telephone_number": "310-691-3644"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "5940 El Escorpion Rd",
            "address_purpose": "LOCATION",
            "city": "Woodland Hills",
            "state": "CA",
            "postal_code": "913673923",
            "country_code": "US",
            "telephone_number": "818-620-6005",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "WALLACE",
        "first_name": "JOHNNY",
        "middle_name": "MICHAEL",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2021-04-15",
        "last_updated": "2021-04-15",
        "certification_date": "2021-04-15",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "106S00000X",
            "taxonomy_group": "",
            "desc": "Behavior Technician",
            "state": "CA",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• David G Wallace
• Denise Michcell Wallace
• Gaybriell Wallace, BCBA
• Jessica Wallace, MFT
• Jiles Lee Wallace, RADT
• Julia Wallace
• Kathleen Wallace
• Kathleen Wallace
• Kia Sytanmia Wallace
• Kristina Marie Wallace

• Behavior Technician in San Francisco, CA
• Providers in San Francisco, CA by specialty
• Behavior Technician in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 15, 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.

Verify at the official NPI Registry.