Individual
LORAN PAIGE WALLACE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LPC
Contact information
Practice address
10613 N HAYDEN RD STE J-103, SCOTTSDALE, AZ 85260-5683
(281) 714-5779
Mailing address
7720 E HEATHERBRAE AVE UNIT 23, SCOTTSDALE, AZ 85251-4052
(281) 714-5779
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
LPC-21109
AZ
Other
Enumeration date
10/04/2022
Last updated
10/04/2022
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