NPIMap

Individual provider Active NPI

Kristen Wallis

  • Marriage & Family Therapist
  • San Diego, CA
National Provider Identifier
1912322140
Registry record updated Jul 21, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Marriage & Family TherapistTaxonomy code 106H00000X
Practice address
7986 Dagget St
San Diego, CA 92111-2321
Phone
(858) 300-0460
Fax
(858) 300-0461
NPI assigned
Feb 25, 2014
Last updated
Jul 21, 2022By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 21, 2022

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Marriage & Family Therapist 106H00000X NU Primary

Addresses

Primary practice location

7986 Dagget St
San Diego, CA 92111-2321

Mailing address

7986 Dagget St
San Diego, CA 92111-2321
Phone (858) 300-0460

Other practice location 1

7155 Mission Gorge Rd
San Diego, CA 92120-1130
Phone (858) 300-0460 ext. 107

Other names 1

  • Ms. Kristen Bennett Former name

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

Practice roles

OrganizationSpecialtyStatusNew patients
Pathways Community Services LLC PastSince Jul 24, 2022 Accepting new patients
Apex Therapy Group, a Marriage and Family Therapy Corporation Marriage & Family Therapist PastSince Jan 1, 2021 Accepting new patients
Pathways Community Services LLC PastSince Jul 24, 2022 Accepting new patients

Organizations & group practices 3

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.

NPI Registry JSON

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

{
    "created_epoch": "1393286400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1658361600000",
    "number": "1912322140",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "7986 DAGGET ST",
            "city": "SAN DIEGO",
            "state": "CA",
            "postal_code": "921112321",
            "telephone_number": "858-300-0460",
            "fax_number": "858-300-0461"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "7986 DAGGET ST",
            "city": "SAN DIEGO",
            "state": "CA",
            "postal_code": "921112321",
            "telephone_number": "858-300-0460",
            "fax_number": "858-300-0461"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "7155 Mission Gorge Rd",
            "address_purpose": "LOCATION",
            "city": "San Diego",
            "state": "CA",
            "postal_code": "921201130",
            "country_code": "US",
            "telephone_number": "858-300-0460 x107",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "WALLIS",
        "first_name": "KRISTEN",
        "name_prefix": "Mrs.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2014-02-25",
        "last_updated": "2022-07-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "106H00000X",
            "taxonomy_group": "",
            "desc": "Marriage & Family Therapist",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "KRISTEN",
            "last_name": "BENNETT",
            "prefix": "MS.",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

Other providers in San Diego, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 21, 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.