Individual provider · Type 1 NPI
Amanda Wallace, MA, LPC
Professional Counselor · Longmont, CO
NPI number
1366635245
Active
Practice location
1907 Kristy Ct
Longmont, CO 80504-7387
Specialties and licenses
| Taxonomy | Code | License |
|---|---|---|
| Professional Counselor Primary | 101YP2500X | 3502 (CO) |
Professional Counselor: Definition to come...
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About NPI 1366635245
Amanda Wallace, MA, LPC's National Provider Identifier is 1366635245, issued on Aug 23, 2007. The primary taxonomy on file is Professional Counselor (101YP2500X), and the practice location is in Longmont, CO. The record was last updated on Aug 23, 2007.