Individual
KATHERINE JOAN WALLACE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LMHC
Contact information
Practice address
719 5TH ST, COLUMBUS, IN 47201-6306
(812) 799-3530
Mailing address
10655 W 650 S, COLUMBUS, IN 47201-8476
(317) 775-9075
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
88001289A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
39004527A
INDIANA BEHAVIORAL HEALTH LICENSING BOARD
IN
Enumeration date
03/21/2021
Last updated
06/05/2023
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