Individual
MRS. BRENDA LEE WALLACE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
M.S.W., L.C.S.W
Contact information
Practice address
323 N 3RD ST, OKEENE, OK 73763-9375
(580) 822-1703
(580) 822-1703
Mailing address
323 N 3RD ST, OKEENE, OK 73763-9375
(580) 822-1703
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
3137
OK
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
200463070B
—
OK
Enumeration date
08/14/2006
Last updated
06/09/2025
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