Individual
MS. JILBA MERYL WALLACE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
MA LPC
Contact information
Practice address
541 OAK STREET, STE 2, FREDERICK, CO 80530
(303) 588-6017
Mailing address
PO BOX 908, FREDERICK, CO 80530-0908
(303) 833-2429
(303) 833-3780
Taxonomy
Speciality
Code
Description
License number
State
101YP2500X
Professional Counselor
Primary
1242
CO
Other
Enumeration date
08/02/2006
Last updated
07/08/2007
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