Individual
DIANA LEE WALL
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.A., LPC
Contact information
Practice address
1217 E COLLEGE ST, BROKEN ARROW, OK 74012-4204
(918) 259-1462
(918) 259-1444
Mailing address
1217 E COLLEGE ST, BROKEN ARROW, OK 74012-4204
(918) 259-1462
(918) 259-1444
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
6542
OK
Other
Enumeration date
08/16/2017
Last updated
07/21/2022
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