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Individual

GLEN KNIGHT WALLACE

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man
Credential
ED.D

Contact information

Practice address
7932 NICHOLSON, OKALHOMA CITY, OK 73162
(405) 728-1173
Mailing address
7932 NICHOLSON, OKALHOMA CITY, OK 73162
(405) 728-1173

Taxonomy

Speciality
Code
Description
License number
State
101YP2500X
Professional Counselor
Primary
535
OK
106H00000X
Marriage & Family Therapist
333
OK

Other

Enumeration date
09/01/2009
Last updated
09/01/2009
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