Individual provider · Type 1 NPI

Kathleen Michelle Wallace, LPC, NCC

Mental Health Counselor · Russellville, AR

NPI number 1508185307 Active

Practice location

110 Skyline Dr
Russellville, AR 72801-3362

Call (479) 968-1298 Map

Fax (479) 890-5364

Specialties and licenses

TaxonomyCodeLicense
Mental Health Counselor Primary 101YM0800XP1507083 (AR)

Mental Health Counselor: Definition to come...

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About NPI 1508185307

Kathleen Michelle Wallace, LPC, NCC's National Provider Identifier is 1508185307, issued on May 19, 2010. The primary taxonomy on file is Mental Health Counselor (101YM0800X), and the practice location is in Russellville, AR. The record was last updated on Feb 15, 2016.