Individual
AMY WALLIS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LPC
Contact information
Practice address
620 NW 5TH ST STE D, MOORE, OK 73160-3947
(405) 208-4469
Mailing address
620 NW 5TH ST STE D, MOORE, OK 73160-3947
(405) 208-4469
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
6156
OK
Other
Enumeration date
08/01/2012
Last updated
02/22/2023
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