Individual
DR. REBECCA M WALLACE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PSY.D.
Contact information
Practice address
1200 CHILDRENS AVE, STE 12400, OKLAHOMA CITY, OK 73104-4637
(405) 271-4407
Mailing address
1200 CHILDRENS AVE, STE 12400, OKLAHOMA CITY, OK 73104-4637
(405) 271-4407
Taxonomy
Speciality
Code
Description
License number
State
103TC0700X
Clinical Psychologist
Primary
1272
OK
103TC0700X
Clinical Psychologist
1508APPL
AR
Other
Enumeration date
08/24/2016
Last updated
04/28/2017
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