Individual
MISTY LEE WALLACE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
7040 LAREDO ST STE D, LAS VEGAS, NV 89117-3044
(775) 237-8629
Mailing address
4151 SPARROW ROCK ST, LAS VEGAS, NV 89129-3288
(775) 237-8629
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
—
—
Other
Enumeration date
09/30/2025
Last updated
09/30/2025
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