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Madison Julia Wallace
Mental Health Counselor in Camarillo, California
NPI 1588142434

Madison Julia Wallace is a Mental Health Counselor based in Camarillo, CA and is specialized in Mental Health. Madison Julia Wallace practices in Camarillo, CA. The NPI Number for Madison Julia Wallace is 1588142434 and holds a License No. (California).

The current practice location address for Madison Julia Wallace is 5284 Adolfo Rd Ste 100, Camarillo, CA and can be reached out via phone at 805-289-0120.

Location: 5284 Adolfo Rd Ste 100, Camarillo, CA, 93012-6790
Profile Details Legacy Identifiers Practice Address Mailing Address Primary Taxonomy
person
Provider Profile Details
NPI Number
1588142434
Provider Name
Madison Julia Wallace
Credential
Provider Entity Type
Individual
Gender
Female
Address
5284 Adolfo Rd Ste 100, Camarillo, CA, 93012-6790
Phone Number
805-289-0120
Fax Number
Provider Enumeration Date
08/02/2018
Last Update Date
03/10/2024
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Provider's Legacy Identifiers
Identifier Type State Issuer
56CC 01 CA MEDI-CAL
institution
Provider Business Practice Location Address Details
Address
5284 Adolfo Rd Ste 100
City
Camarillo
State
California
Zip
93012-6790
Phone Number
805-289-0120
Fax Number
person
Provider Business Mailing Address Details
Address
5284 Adolfo Rd Ste 100
City
Camarillo
State
California
Zip
93012-6790
Phone Number
805-289-0120
Fax Number
person
Provider's Taxonomy Details 1
Type
Behavioral Health & Social Service Providers
Classification
Counselor
Speciality
Mental Health
Taxonomy
101YM0800X
License No.
()
Definition
Definition to come...
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