Individual
KELLY LOVE WALLACE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
M. ED.
Contact information
Practice address
2817 STONEBROOK RD, EDMOND, OK 73003-2105
(214) 600-3503
Mailing address
2817 STONEBROOK RD, EDMOND, OK 73003-2105
(214) 600-3503
Taxonomy
Speciality
Code
Description
License number
State
101YP2500X
Professional Counselor
Primary
77947
TX
Other
Enumeration date
08/19/2019
Last updated
08/27/2021
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