Individual
MRS. BROOKE MARY WALLACE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LCSW, BCD
Contact information
Practice address
2200 BERGQUIST DR, SUITE 1, LACKLAND A F B, TX 78236-9907
(210) 508-9058
Mailing address
3551 ROGER BROOKE DR, JBSA FT SAM HOUSTON, TX 78234-4504
(210) 508-9058
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
51643
TX
Other
Enumeration date
02/05/2007
Last updated
04/17/2018
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