Individual provider · Type 1 NPI

Robert E. Wallace

Mental Health Counselor · Coos Bay, OR

NPI number 1679455703 Active

Practice location

93463 Alabama Ln
Coos Bay, OR 97420-3977

Call (660) 525-6182 Map

Mailing address

PO Box 653
Coos Bay, OR 97420-0124

Specialties and licenses

TaxonomyCodeLicense
Mental Health Counselor Primary 101YM0800X25-QMHP-R-3536 (OR)

Mental Health Counselor: Definition to come...

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About NPI 1679455703

Robert E. Wallace's National Provider Identifier is 1679455703, issued on Jul 21, 2025. The primary taxonomy on file is Mental Health Counselor (101YM0800X), and the practice location is in Coos Bay, OR. The record was last updated on Jul 21, 2025.