Individual provider · Type 1 NPI
Chantel Lee Wallace
Mental Health Counselor · Blackfoot, ID
NPI number
1669234308
Active
Practice location
581 N Ash St
Blackfoot, ID 83221-2223
Specialties and licenses
| Taxonomy | Code | License |
|---|---|---|
| Mental Health Counselor Primary | 101YM0800X | LMSW-43731 (ID) |
Mental Health Counselor: Definition to come...
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About NPI 1669234308
Chantel Lee Wallace's National Provider Identifier is 1669234308, issued on Jan 29, 2024. The primary taxonomy on file is Mental Health Counselor (101YM0800X), and the practice location is in Blackfoot, ID. The record was last updated on Jan 29, 2024.