Individual
BETH WALLACE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
1018 24TH AVE NW STE 110, NORMAN, OK 73069-6556
(855) 223-7123
(619) 374-7134
Mailing address
PO BOX 33568, SAN DIEGO, CA 92163-3568
(855) 223-7123
(619) 374-7134
Taxonomy
Speciality
Code
Description
License number
State
106S00000X
Behavior Technician
Primary
—
—
Other
Enumeration date
05/12/2023
Last updated
05/12/2023
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