Individual
KIMBERLY WALLACE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LMFT
Contact information
Practice address
600 E CARMEL DR, SUITE 143, CARMEL, IN 46032-2803
(317) 730-5155
Mailing address
3647 TAHOE CT, CARMEL, IN 46033-4152
(317) 363-7266
Taxonomy
Speciality
Code
Description
License number
State
101Y00000X
Counselor
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
100270530A
—
IN
Enumeration date
09/14/2009
Last updated
12/31/2012
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