Organization
WALLACE PLACE IN THE PINES
Active
Other names
Wallace Place In The Pines
Organization subpart
No
Provider details
NPI number
Authorized official
BARBARA ANN WALLACE (OWNER)
(936) 662-5617
Entity
Organization
Contact information
Practice address
1706 DAVIS AVE, LIVINGSTON, TX 77351-2004
(936) 223-4542
Mailing address
1706 DAVIS AVE, LIVINGSTON, TX 77351-2004
(936) 223-4542
Taxonomy
Speciality
Code
Description
License number
State
102X00000X
Poetry Therapist
—
—
320800000X
Mental Illness Community Based Residential Treatment Facility
Primary
—
—
320900000X
Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
—
—
322D00000X
Emotionally Disturbed Childrens' Residential Treatment Facility
—
—
323P00000X
Psychiatric Residential Treatment Facility
—
—
385HR2060X
Child Intellectual and/or Developmental Disabilities Respite Care
—
—
Other
Enumeration date
05/23/2019
Last updated
06/04/2019
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