Individual
SHAROLYN JAN WALLACE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
PHD, LCSW
Contact information
Practice address
3015 E SKELLY DR, TULSA, OK 74105-6317
(918) 665-0208
(918) 665-0216
Mailing address
PO BOX 27451, TULSA, OK 74149-0451
(918) 639-4574
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
1803-LCSW
OK
Other
Enumeration date
11/01/2006
Last updated
07/08/2007
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