Active NPI
Edna Wallace, LMFT
- Marriage & Family Therapist
- Los Altos, CA
National Provider Identifier
1922419241
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Marriage & Family Therapist
- License
- 46206
- Practice address
- 851 Fremont Ave Ste 214
Los Altos, CA 94024-5602 - Phone
- (408) 296-0966
- NPI assigned
- May 9, 2014
- 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 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Marriage & Family Therapist | 106H00000X | 46206 | CA | Primary |
Addresses
Primary practice location
851 Fremont Ave Ste 214
Los Altos, CA 94024-5602
Mailing address
PO Box 4465
Mountain View, CA 94040-0465
Phone (408) 296-0966
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
- Opted out of Medicare
- Yes, effective Jan 1, 2024 through Jan 1, 2028
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 46206 | CA | MD | Endodontist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1399593600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1399593600000",
"number": "1922419241",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 4465",
"city": "MOUNTAIN VIEW",
"state": "CA",
"postal_code": "940400465",
"telephone_number": "408-296-0966"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "851 FREMONT AVE STE 214",
"city": "LOS ALTOS",
"state": "CA",
"postal_code": "940245602",
"telephone_number": "408-296-0966"
}
],
"practiceLocations": [],
"basic": {
"last_name": "WALLACE",
"first_name": "EDNA",
"credential": "LMFT",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2014-05-09",
"last_updated": "2014-05-09",
"status": "A"
},
"taxonomies": [
{
"code": "106H00000X",
"taxonomy_group": "",
"desc": "Marriage & Family Therapist",
"state": "CA",
"license": "46206",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Los Altos, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 9, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Opt Out Affidavits.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.