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Individual

MRS. MYRIAH DAWN WALLACE

Active
Sole proprietor
No

Provider details

NPI number
Gender
F
Credential
LPC

Contact information

Practice address
212 WASHINGTON AVE # 245, WEST PLAINS, MO 65775-9998
(417) 580-9774
Mailing address
PO BOX 245, WEST PLAINS, MO 65775-0245
(417) 257-4999

Taxonomy

Speciality
Code
Description
License number
State
101Y00000X
Counselor
101YM0800X
Mental Health Counselor
101YP2500X
Professional Counselor
Primary
2011008967
MO

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
2011008967
MO
Enumeration date
02/23/2011
Last updated
03/25/2026
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