Individual
CARLEE D P WALLACE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LMFT
Contact information
Practice address
1406 W LITTLE CREEK DR, WEST JORDAN, UT 84088-6543
(208) 690-1270
Mailing address
1406 W LITTLE CREEK DR, WEST JORDAN, UT 84088-6543
(208) 690-1270
Taxonomy
Speciality
Code
Description
License number
State
106H00000X
Marriage & Family Therapist
Primary
—
—
Other
Enumeration date
01/24/2024
Last updated
05/03/2024
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