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Individual

LESLIE DAWN WALLACE

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
F

Contact information

Practice address
908 NE 84TH ST, OKLAHOMA CITY, OK 73114-3912
(405) 608-0086
(405) 419-9203
Mailing address
908 NE 84TH ST, OKLAHOMA CITY, OK 73114-3912
(405) 608-0086
(405) 419-9203

Taxonomy

Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
OK

Other

Enumeration date
06/13/2012
Last updated
06/13/2012
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