Individual provider · Type 1 NPI

Misty Lee Wallace

Mental Health Counselor · Las Vegas, NV

NPI number 1104790625 Active

Practice location

7040 Laredo St Ste D
Las Vegas, NV 89117-3044

Call (775) 237-8629 Map

Mailing address

4151 Sparrow Rock St
Las Vegas, NV 89129-3288

Specialties and licenses

TaxonomyCodeLicense
Mental Health Counselor Primary 101YM0800XNone listed

Mental Health Counselor: Definition to come...

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About NPI 1104790625

Misty Lee Wallace's National Provider Identifier is 1104790625, issued on Sep 30, 2025. The primary taxonomy on file is Mental Health Counselor (101YM0800X), and the practice location is in Las Vegas, NV. The record was last updated on Sep 30, 2025.