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Search › California › 390200000X

Jefferey Wallace

NPI 1902023070 · on the registry since 2007

Practice

Address
1400 Emeline Ave Bldg K
Santa Cruz, CA 95060
Phone
(831) 345-7746
Organisation at this address
Santa Cruz County
Fee-For-Service Lcsw
County Of Santa Cruz
County Of Santa Cruz
County Of Santa Cruz
Inferred from a shared address, not stated in the registry.
Clinicians at this address
236

Additional practice sites

  • 6980 Chestnut St, Gilroy, CA

Registry record

Primary taxonomy
390200000X
390200000X
Also registered as
101Y00000X
Licence states on file
NULL
From the registry's licence fields, which are often incomplete.
Sex
Male
Record last updated
2025-08-26
Status
Not present in the most recent federal file

Source: CMS National Plan and Provider Enumeration System. Registration is not the same as practising, and the registry records no retirement — some people listed here no longer practise. More in California