Individual
MRS. ANNETTE S. WALLACE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LPC
Contact information
Practice address
6931 S 66TH EAST AVE, 115, TULSA, OK 74133-1754
(918) 645-7853
Mailing address
9066 S. 264TH E. AVE., BROKEN ARROW, OK 74014
(918) 645-7853
Taxonomy
Speciality
Code
Description
License number
State
101YP2500X
Professional Counselor
Primary
2020
OK
Other
Enumeration date
07/07/2011
Last updated
07/07/2011
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