EVERETT WALLACE NPI 1528655107

NPI Information

NPI: 1528655107
Provider Name: EVERETT WALLACE
Classification: Counselor - 101YA0400X
Entity Type: Individual

Specialization: Addiction (Substance Use Disorder)

Address:
44374 PALM ST
INDIO, CA
ZIP 92201
Phone: (760) 342-6616
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Everett Wallace is an addiction (substance use disorder) counselor in Indio, CA. Everett Wallace NPI is 1528655107. The provider is registered as an individual entity type.

The NPPES NPI record indicates the provider is a male.

The provider's business location address is:

44374 PALM ST
INDIO, CA
ZIP 92201-117
Phone: (760) 342-6616

The enumeration date for this NPI number is 12/29/2020 and was last updated on 12/29/2020.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No.	Taxonomy Code	Taxonomy Clasification	Taxonomy Specialization	License Number	License State	Primary
1	101YA0400X	Counselor	Addiction (Substance Use Disorder)	CI30830920	CALIFORNIA	Yes

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 4/28/2024

NPI Synchronization or Removal

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