Individual
MR. BILLIE M WALLIS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
LPC-S
Contact information
Practice address
804 W CHOCTAW AVE, CHICKASHA, OK 73018-2310
(405) 222-0622
Mailing address
4205 NUGGET LN, TUTTLE, OK 73089-9213
(405) 381-9140
Taxonomy
Speciality
Code
Description
License number
State
101YP2500X
Professional Counselor
Primary
5859
OK
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
101YP2500X
—
OK
Enumeration date
04/05/2013
Last updated
08/19/2024
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