Individual provider · Type 1 NPI

Angela D. Wallace

Mental Health Counselor · Shawnee, OK

NPI number 1114204450 Active

Practice location

101 N Union Ave
Shawnee, OK 74801-7067

Fax (405) 878-1138

Specialties and licenses

TaxonomyCodeLicense
Mental Health Counselor Primary 101YM0800XNone listed

Mental Health Counselor: Definition to come...

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About NPI 1114204450

Angela D. Wallace's National Provider Identifier is 1114204450, issued on Nov 15, 2011. The primary taxonomy on file is Mental Health Counselor (101YM0800X), and the practice location is in Shawnee, OK. The record was last updated on Nov 15, 2011.