Individual
STEPHEN L. WALLACE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
LPC, CAC II
Contact information
Practice address
4601 CORBETT DR, FORT COLLINS, CO 80528-9579
(970) 207-4800
(970) 207-4805
Mailing address
4601 CORBETT DR, FORT COLLINS, CO 80528-9579
(970) 207-4800
(970) 207-4805
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
5301
CO
101YP2500X
Professional Counselor
639
CO
Other
Enumeration date
08/30/2006
Last updated
04/26/2026
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