Individual
MR. MICHAEL EUGENE WALLACE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
MA
Contact information
Practice address
201 E LIBERTY ST, SUITE 2, ANN ARBOR, MI 48104-2118
(734) 330-3580
Mailing address
201 E. LIBERTY ST., SUITE 2, ANN ARBOR, MI 48104
(734) 330-3580
Taxonomy
Speciality
Code
Description
License number
State
103TC0700X
Clinical Psychologist
Primary
6301008847
MI
Other
Enumeration date
10/29/2010
Last updated
10/29/2010
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