Individual
MIRIAM WALL
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
205 S J T STITES, SALLISAW, OK 74955-9301
(918) 775-7787
Mailing address
205 S J T STITES, SALLISAW, OK 74955-9301
(918) 775-7787
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
—
—
Other
Enumeration date
07/09/2014
Last updated
07/09/2014
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