Individual
HENRY HUGH WALLACE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
6236 RHONES QUARTER RD LOT 13, TYLER, TX 75707-6479
(903) 952-9869
Mailing address
6236 RHONES QUARTER RD LOT 13, TYLER, TX 75707-6479
(903) 952-9869
Taxonomy
Speciality
Code
Description
License number
State
106H00000X
Marriage & Family Therapist
Primary
201549
TX
Other
Enumeration date
07/05/2019
Last updated
07/05/2019
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