Provider Demographics
NPI:1558482414
Name:WALLACE, ARLA STRASSBURG (PHD)
Entity Type:Individual
Prefix:DR
First Name:ARLA
Middle Name:STRASSBURG
Last Name:WALLACE
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1232 15TH ST
Mailing Address - Street 2:SUITE C
Mailing Address - City:SANTA MONICA
Mailing Address - State:CA
Mailing Address - Zip Code:90404-1123
Mailing Address - Country:US
Mailing Address - Phone:310-395-5377
Mailing Address - Fax:914-992-9396
Practice Address - Street 1:1232 15TH ST
Practice Address - Street 2:SUITE C
Practice Address - City:SANTA MONICA
Practice Address - State:CA
Practice Address - Zip Code:90404-1123
Practice Address - Country:US
Practice Address - Phone:310-395-5377
Practice Address - Fax:914-992-9396
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY6378103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CACP6378Medicare ID - Type Unspecified