Active NPI
Tiffany Wallace
- Mental Health Counselor
- Bellingham, MA
National Provider Identifier
1891418828
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Mental Health Counselor
- License
- S01895123
- Practice address
- 201 Village LN
Bellingham, MA 02019-1136 - Phone
- (508) 663-9758
- NPI assigned
- Sep 23, 2022
- Last updated
- Sep 23, 2022
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Mental Health Counselor | 101YM0800X | S01895123 | MA | Primary |
| Social Worker | 104100000X | NU |
Addresses
Primary practice location
201 Village LN
Bellingham, MA 02019-1136
Mailing address
201 Village LN
Bellingham, MA 02019-1136
Phone (508) 663-9758
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 |
|---|---|---|---|
| S01895123 | MA | MD | Mental Health Counselor |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1663891200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1663891200000",
"number": "1891418828",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "201 VILLAGE LN",
"city": "BELLINGHAM",
"state": "MA",
"postal_code": "020191136",
"telephone_number": "508-663-9758"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "201 VILLAGE LN",
"city": "BELLINGHAM",
"state": "MA",
"postal_code": "020191136",
"telephone_number": "508-663-9758"
}
],
"practiceLocations": [],
"basic": {
"last_name": "WALLACE",
"first_name": "TIFFANY",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2022-09-23",
"last_updated": "2022-09-23",
"certification_date": "2022-09-23",
"status": "A"
},
"taxonomies": [
{
"code": "101YM0800X",
"taxonomy_group": "",
"desc": "Counselor, Mental Health",
"state": "MA",
"license": "S01895123",
"primary": true
},
{
"code": "104100000X",
"taxonomy_group": "",
"desc": "Social Worker",
"state": "NU",
"license": null,
"primary": false
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Bellingham, MA
- Town of Bellingham
- Kelly McGowan Viera, MA, LSAC
- Visology Inc (VISOLOGY @Bellingham)
- Wal-Mart Stores East , LP (Wal-Mart Pharmacy 10-1918)
- Walgreen Co (Walgreens #10268)
- John Arthur Walsh, R.PH. MS
- Kerry Lynne Walsh, PT
- Laurie Alexander Warren, M.S.
- Woonsocket Urgent Care, PC (Bellingham Urgent Care)
- Charbel Younes, FNP-BC
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 23, 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.