Individual
MISTY WALLACE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
3140 W BRITTON RD, STE 204, OKLAHOMA CITY, OK 73120-2074
(405) 608-4425
Mailing address
3041 SW 64TH TER, OKLAHOMA CITY, OK 73159-1317
Taxonomy
Speciality
Code
Description
License number
State
103K00000X
Behavior Analyst
Primary
—
OK
Other
Enumeration date
06/02/2011
Last updated
06/02/2011
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