Individual
HAROLD WAYNE WALLACE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
LPC
Contact information
Practice address
21 WALLBROOK TRL, ODESSA, TX 79762-5213
(432) 550-4563
Mailing address
21 WALLBROOK TRL, ODESSA, TX 79762-5213
(432) 550-4563
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
10091
TX
Other
Enumeration date
01/11/2012
Last updated
01/11/2012
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