Active NPI
Grayson Wallen, LPCC
- Professional Counselor
- Encinitas, CA
National Provider Identifier
1962007369
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Professional Counselor
- License
- 5227
- Practice address
- 169 Saxony Rd Ste 205
Encinitas, CA 92024-6780 - Phone
- (480) 234-8363
- NPI assigned
- Dec 2, 2020
- Sex
- Male
- Sole proprietor
- No
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 |
|---|---|---|---|---|
| Professional Counselor | 101YP2500X | 5227 | CA | Primary |
Addresses
Primary practice location
169 Saxony Rd Ste 205
Encinitas, CA 92024-6780
Mailing address
169 Saxony Rd Ste 205
Encinitas, CA 92024-6780
Phone (480) 234-8363
Electronic endpoints 1
| Type | Endpoint | Use | Affiliation |
|---|---|---|---|
| CONNECT URL | grayson@graysonwallen.com | Direct |
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 17, 2024 through Jan 17, 2028
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 5227 | CA | MD | Professional Counselor |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1606867200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1660694400000",
"number": "1962007369",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "169 SAXONY RD STE 205",
"city": "ENCINITAS",
"state": "CA",
"postal_code": "920246780",
"telephone_number": "480-234-8363"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "169 SAXONY RD STE 205",
"city": "ENCINITAS",
"state": "CA",
"postal_code": "920246780",
"telephone_number": "480-234-8363"
}
],
"practiceLocations": [],
"basic": {
"last_name": "WALLEN",
"first_name": "GRAYSON",
"credential": "LPCC",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2020-12-02",
"last_updated": "2022-08-17",
"certification_date": "2022-08-17",
"status": "A"
},
"taxonomies": [
{
"code": "101YP2500X",
"taxonomy_group": "",
"desc": "Counselor, Professional",
"state": "CA",
"license": "5227",
"primary": true
}
],
"identifiers": [],
"endpoints": [
{
"endpointType": "CONNECT",
"endpointTypeDescription": "CONNECT URL",
"endpoint": "grayson@graysonwallen.com",
"affiliation": "N",
"endpointDescription": "GW EMail",
"use": "DIRECT",
"useDescription": "Direct",
"contentType": "CSV",
"contentTypeDescription": "CSV",
"address_1": "4025 Camino Del Rio S # 250A",
"city": "San Diego",
"state": "CA",
"country_code": "US",
"postal_code": "921084107",
"country_name": "United States",
"address_type": "DOM"
}
],
"other_names": []
}Other providers in Encinitas, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 17, 2022; 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.