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Individual
LISA M WALLACE
Active
Individual
LISA M WALLACE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MA, LPC
Taxonomy
Speciality
Code
Description
License number
State
101YP2500X
Professional Counselor
Primary
5913
CO
101YP2500X
Professional Counselor
906
WY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
312410
BS OF WY
WY
Enumeration date
11/30/2005
Last updated
12/01/2025
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