Individual
MICHAEL JON WALLACE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
CPSW
Contact information
Practice address
760 N MOTEL BLVD, LAS CRUCES, NM 88007-4169
(575) 527-7975
(575) 674-2861
Mailing address
385 CALLE DE ALEGRA BLDG A, LAS CRUCES, NM 88005-3423
(575) 526-1105
(575) 524-4266
Taxonomy
Speciality
Code
Description
License number
State
175T00000X
Peer Specialist
Primary
—
NM
Other
Enumeration date
01/06/2026
Last updated
01/06/2026
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