Organization
LIFEWELL MIND AND BODY CLINIC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MYRIAH WALLACE LPC (OWNER)
(417) 257-4999
Entity
Organization
Contact information
Practice address
12318 STATE RTE E, WEST PLAINS, MO 65775-7530
(417) 257-4999
Mailing address
12318 STATE RTE E, WEST PLAINS, MO 65775-7530
(417) 257-4999
Taxonomy
Speciality
Code
Description
License number
State
101Y00000X
Counselor
—
—
101YM0800X
Mental Health Counselor
—
—
101YP2500X
Professional Counselor
Primary
—
—
Other
Enumeration date
10/10/2025
Last updated
10/10/2025
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