Individual
LILA ANANDA WALLACE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LMFT
Contact information
Practice address
306 W ADAMS AVE, FAIRFIELD, IA 52556-3314
(641) 455-9630
Mailing address
306 W ADAMS AVE, FAIRFIELD, IA 52556-3314
(641) 455-9630
Taxonomy
Speciality
Code
Description
License number
State
106H00000X
Marriage & Family Therapist
Primary
94538
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
94538
MFT LICENSE
CA
Enumeration date
04/11/2011
Last updated
03/12/2025
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