DR. IAN JOSEPH WALLACE (NPI# 1013143262) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1013143262 |
| Entity Type | Individual |
| Full Name | DR. IAN JOSEPH WALLACE |
| Credential | PH.D. |
| Practice Address |
200 Maritime Academy Dr The California Maritime Academy, Student Health Service Vallejo CA 94590-8181 |
| Practice Telephone | 7076541170 |
| Practice Fax Number | 7076541171 |
| Mailing Telephone | 7076541170 |
| Mailing Fax Number | 7076541171 |
| Enumeration Date | 2009-06-02 |
| Last Update Date | 2013-07-23 |
| Gender Code | M |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 103T00000X | Psychologist | PSY# 23646 | CA | Behavioral Health & Social Service Providers |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1063732758 | Ian Wallace | Family Medicine | 3291 Loma Vista Rd Rm 120, Ventura, CA 93003-3099 | 2010-06-04 |
| 1699385708 | Ian Wallace | Occupational Therapist | 10475 Perry Hwy Ste 106g, Wexford, PA 15090-9213 | 2020-08-04 |
| 1770011124 | Ian Wallace | Case Manager/Care Coordinator | 151 W Brundage St, Sheridan, WY 82801-4217 | 2017-05-30 |
| 1942514930 | Ian Wallace | Genetic Counselor, MS | 1620 Se Summit Ct, Pullman, WA 99163-5540 | 2010-08-02 |
| Street Address |
200 MARITIME ACADEMY DR THE CALIFORNIA MARITIME ACADEMY, STUDENT HEALTH SERVICE |
| City | VALLEJO |
| State | CA |
| Zip Code | 94590-8181 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1902029879 | Christine Smith | Nurse Practitioner | 200 Maritime Academy Dr, Vallejo, CA 94590-8181 | 2007-04-10 |
| 1689941171 | Cathleen Underwood Coulman | Internal Medicine | 200 Maritime Academy Dr, Vallejo, CA 94590-8181 | 2011-11-28 |
| 1073813341 | California Maritime Academy | Clinic/Center | 200 Maritime Academy Dr, Vallejo, CA 94590-8181 | 2010-11-02 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1265051445 | Jaspreet Bains | Licensed Vocational Nurse | 508 Alabama Street, Vallejo, CA 94590 | 2020-04-08 |
| 1467097527 | Deneane Hannon | Behavioral Analyst | 238 Georgia St. Ste 102, Vallejo, CA 94590 | 2019-11-13 |
| 1780243196 | Abla Harara Almoraissi | Health Educator | John F. Kennedy Library, 505 Santa Clara St, Vallejo, CA 94590 | 2019-06-10 |
| 1891264461 | Brian Emory Kellogg | Marriage & Family Therapist | 525 Oregon St., Php/iop, Vallejo, CA 94590 | 2018-11-13 |
| 1952801862 | Carica Theresa Saraza Macariola | Specialist/Technologist | 1007 Solano Avenue, Vallejo, CA 94590 | 2018-02-16 |
| 1770007973 | Deborah A Johnson-white | Licensed Vocational Nurse | 908 Tuolumne, Vallejo, CA 94590 | 2017-07-29 |
| 1306378260 | Edgar Diaz | Counselor | 236 Georgia Street Suite 101, Vallejo, CA 94590 | 2017-03-30 |
| 1528440096 | Soren Perry | Counselor | 236 Georgia St., Vallejo, CA 94590 | 2015-06-22 |
| 1518366327 | Kimberly A Holland | Counselor | 631 Tennessee Street Suite 201, Vallejo, CA 94590 | 2014-08-18 |
| 1841605193 | Lawana Lofton | Psychologist | 88 Valle Vista Drive, Unit 6310, Vallejo, CA 94590 | 2014-06-25 |
| Find all providers in zip 94590 | ||||
| Taxonomy Code | 103T00000X |
| Grouping | Behavioral Health & Social Service Providers |
| Classification | Psychologist |
| A psychologist is an individual who is licensed to practice psychology which is defined as the observation, description, evaluation, interpretation, and modification of human behavior by the application of psychological principles, methods, and procedures, for the purpose of preventing or eliminating symptomatic, maladaptive, or undesired behavior and of enhancing interpersonal relationships, work and life adjustment, personal effectiveness, behavioral health, and mental health. The practice of psychology includes, but is not limited to, psychological testing and the evaluation or assessment of personal characteristics, such as intelligence, personality, abilities, interests, aptitudes, and neuropsychological functioning; counseling, psychoanalysis, psychotherapy, hypnosis, biofeedback, and behavior analysis and therapy; diagnosis and treatment of mental and emotional disorder or disability, alcoholism and substance abuse, disorders of habit or conduct, as well as of the psychological aspects of physical illness, accident, injury, or disability; and psycheducational evaluation, therapy, remediation, and consultation. Psychological services may be rendered to individuals, families, groups and the public. |
| Notes: Source: American Psychological Association [1/1/2007: modified definition] |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1285103622 | Elena Friio | Psychologist | 150 Glen Cove Marina Rd E # 21, Vallejo, CA 94591-7292 | 2018-11-15 |
| 1952861445 | Neda Soussanbari | Psychologist | 975 Sereno Dr, Vallejo, CA 94589-2441 | 2019-03-21 |
| 1063824019 | Shasta Marie Ihorn | Psychologist | 1761 Broadway St, Ste 100, Vallejo, CA 94589-2226 | 2014-05-27 |
| 1013250323 | Richard Henry Von Feldt | Psychologist | 800 Sereno Dr, Vallejo, CA 94589-2411 | 2013-04-04 |
| 1417296211 | Andrinee Wilson | Psychologist | 800 Sereno Dr, Vallejo, CA 94589-2411 | 2013-02-14 |
| 1164790432 | Kristin Lee Koperski | Psychologist | 1761 Broadway St, Suite 100, Vallejo, CA 94589-2226 | 2011-12-01 |
| 1871804856 | Maria Ortiz-baker | Psychologist | 1761 Broadway St Ste 100, Vallejo, CA 94589-2227 | 2010-06-24 |
| 1447305396 | Kathryn Wetzler | Psychologist | 975 Sereno Dr, Vallejo, CA 94589-2441 | 2007-01-23 |
| 1073663936 | Patricia J Dwyer | Psychologist | 975 Sereno Dr, Bay View South, Vallejo, CA 94589-2441 | 2007-01-11 |
| 1942378716 | Stephanie Ann Zone | Psychologist | 1761 Broadway, Suite 100, Vallejo, CA 94589 | 2006-12-01 |
| Find all providers in VALLEJO | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.