JERRON WALLACE (NPI# 1033589247) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1033589247 |
| Entity Type | Individual |
| Full Name | JERRON WALLACE |
| Credential | LMSW |
| Practice Address |
912 1st St Nw Albuquerque NM 87102-2355 |
| Practice Telephone | 5052249777 |
| Mailing Telephone | 5052249777 |
| Enumeration Date | 2015-09-30 |
| Last Update Date | 2017-01-19 |
| Gender Code | M |
| Is Sole Proprietor | Y |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 101YA0400X |
Counselor Specialization: Addiction (Substance Use Disorder) |
X-09336 | NM | Behavioral Health & Social Service Providers |
| Street Address |
912 1ST ST NW |
| City | ALBUQUERQUE |
| State | NM |
| Zip Code | 87102-2355 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1205114816 | Christian Shaw | Preventive Medicine | 912 1st St Nw, Albuquerque, NM 87102 | 2011-07-31 |
| 1407456742 | Gabriela Gallegos | Peer Specialist | 912 1st St Nw, Albuquerque, NM 87102-2355 | 2020-10-27 |
| 1942823125 | Dawn Green | Peer Specialist | 912 1st St Nw, Albuquerque, NM 87102-2355 | 2020-05-22 |
| 1548890007 | James K Aragon | Counselor | 912 1st St Nw, Albuquerque, NM 87102-2355 | 2020-01-23 |
| 1730742941 | Christina R Hynes | Peer Specialist | 912 1st St Nw, Albuquerque, NM 87102-2355 | 2019-04-15 |
| 1134782337 | Jason Allen Jackson | Peer Specialist | 912 1st St Nw, Albuquerque, NM 87102-2355 | 2019-04-15 |
| 1518430669 | Brittney Hogan | Peer Specialist | 912 1st St Nw, Albuquerque, NM 87102-2355 | 2019-01-10 |
| 1558830927 | Shelly Brooke Dallas | Counselor | 912 1st St Nw, Albuquerque, NM 87102-2355 | 2018-11-15 |
| 1427526656 | Patrick Kochersperger | Peer Specialist | 912 1st St Nw, Albuquerque, NM 87102-2355 | 2018-11-06 |
| 1730665274 | Irwin Foster | Peer Specialist | 912 1st St Nw, Albuquerque, NM 87102-2355 | 2018-07-18 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1407454937 | Julie Wood | Acupuncturist | 1600 Luna Circle Nw, Albuquerque, NM 87102 | 2020-10-16 |
| 1770121410 | Emily Perez | Counselor | 218 Broadway Ne, Albuquerque, NM 87102 | 2019-12-12 |
| 1417503392 | Tess Holtry | Behavior Technician | 1424 Walter St Nw, Albuquerque, NM 87102 | 2019-08-15 |
| 1942867486 | Christy E Cheromiah | Behavioral Analyst | Open Skies Helathcare, 707 Broadway Blvd Ne, Albuquerque, NM 87102 | 2019-05-21 |
| 1730744103 | Faith Petra Maxwell | Behavior Technician | 900 Arno St, Albuquerque, NM 87102 | 2019-05-01 |
| 1568923761 | Storm Swinford | Behavioral Analyst | Open Skies Healthcare, 707 Broadway Blvd Ne, Albuquerque, NM 87102 | 2019-03-29 |
| 1093276651 | Tina Marie Trujillo | Behavioral Analyst | Open Skies Health Care, 707 Broadway Blvd Ne, Albuquerque, NM 87102 | 2019-03-27 |
| 1861950370 | Meghan Montoya | Student in an Organized Health Care Education/Training Program | 801 Camino De Salud, Albuquerque, NM 87102 | 2019-03-05 |
| 1174099329 | Dilshani N Tyson | Counselor | 600 1st Street Nw Ste 200, Albuquerque, NM 87102 | 2018-10-15 |
| 1962987925 | Tania L Goldfeder | Social Worker | New Mexico Solutions, 707 Broadway Ne Suite 500, Albuquerque, NM 87102 | 2018-09-26 |
| Find all providers in zip 87102 | ||||
| Taxonomy Code | 101YA0400X |
| Grouping | Behavioral Health & Social Service Providers |
| Classification | Counselor |
| Specialization | Addiction (Substance Use Disorder) |
| Definition to come... |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1699395368 | Roadrunner Recovery Services LLC | Counselor | 505 13th St Sw Apt A, Albuquerque, NM 87102-2873 | 2020-04-22 |
| 1104465152 | Laura Aubert | Counselor | 1108 Vassar Dr Se, Albuquerque, NM 87106-2959 | 2019-12-21 |
| 1245719665 | Ashley Tapia | Counselor | 125 Candelaria Rd Nw, Albuquerque, NM 87107-2210 | 2018-08-07 |
| 1194226415 | Aurora R Cata | Counselor | 1528 5 Pts Rd Sw, Albuquerque, NM 87105-3179 | 2018-02-22 |
| 1689198582 | Margaret Ann Garberina | Counselor | 4031 Mackland Ave Ne, Albuquerque, NM 87110-7711 | 2017-08-01 |
| 1699229559 | Louise Blazquez | Counselor | 8000 Roma Ave Ne, Albuquerque, NM 87108-2334 | 2016-08-09 |
| 1861848632 | Recovery Services of New Mexico, LLC | Counselor | 1711 Isleta Blvd Sw, Albuquerque, NM 87105-4635 | 2016-05-10 |
| 1578927711 | Clarence Mills | Counselor | 1528 Five Points Rd Nw, Albuquerque, NM 87105 | 2016-04-13 |
| 1285095257 | Robert Barnes | Counselor | 8613 Democracy Rd Ne, Albuquerque, NM 87109-5181 | 2016-03-17 |
| 1366809089 | Elizabeth Hawkins | Counselor | 7005 Avenida La Costa Ne, Albuquerque, NM 87109-3927 | 2016-01-26 |
| Find all providers in ALBUQUERQUE | ||||
| City | ALBUQUERQUE |
| Zip Code | 87102 |
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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.