Individual
COURTNEY WALLACE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
501 S COLTRANE RD, EDMOND, OK 73034-6714
(580) 318-9415
Mailing address
501 S COLTRANE RD, EDMOND, OK 73034-6714
(580) 318-9415
Taxonomy
Speciality
Code
Description
License number
State
106S00000X
Behavior Technician
Primary
RBT-25-0086-1107719
OK
Other
Enumeration date
01/29/2026
Last updated
01/29/2026
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