Individual
AMANDA WALLACE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
8401 HARCOURT RD, INDIANAPOLIS, IN 46260-2073
(317) 338-4896
(317) 338-4890
Mailing address
8401 HARCOURT RD, INDIANAPOLIS, IN 46260-2073
(317) 338-4896
(317) 338-4890
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
10594
SC
101YM0800X
Mental Health Counselor
Primary
39004417A
IN
101YM0800X
Mental Health Counselor
88001290A
IN
Other
Enumeration date
03/19/2021
Last updated
04/19/2025
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