Individual
KESHAWN WALLACE
Active
Sole proprietor
No
Provider details
NPI number
Gender
X
Credential
LPC-ASSOCIATE
Contact information
Practice address
2763 W I 240 SERVICE RD APT 63G, OKLAHOMA CITY, OK 73159-3784
(918) 986-5918
Mailing address
2763 W I 240 SERVICE RD APT 63G, OKLAHOMA CITY, OK 73159-3784
(918) 986-5918
Taxonomy
Speciality
Code
Description
License number
State
101YP2500X
Professional Counselor
Primary
101414
TX
171M00000X
Case Manager/Care Coordinator
Primary
—
—
Other
Enumeration date
04/30/2024
Last updated
03/02/2026
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