=====================================================
General NPI Number Information
=====================================================
NPI Number | 1538998448
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | CORAL WAVES MARKETING
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/29/2024
-----------------------------------------------------
Last Update Date | 01/08/2026
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1100 CIVIC CENTER BLVD STE 302
-----------------------------------------------------
City | YUBA CITY
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 95993-3004
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 530-635-5742
-----------------------------------------------------
Fax | 530-869-5315
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1175 LEWIS OAK RD
-----------------------------------------------------
City | GRIDLEY
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 95948-9306
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 801-815-0598
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | CEO
-----------------------------------------------------
Name | MRS. LYNDI LITTLE WALLACE
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 801-815-0598
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 101YM0800X
-----------------------------------------------------
Taxonomy Name | Mental Health Counselor
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------