MR. Michael Eugene Wallace, MA

NPI #1003116658 in Ann Arbor, Michigan

Provider Information

NPI Number: 1003116658
Entity Type: Individual
Name: MR. Michael Eugene Wallace, MA
Gender: Not Specified
Sole Proprietor: Yes
Primary Specialty: Psychologist - Clinical
Credential: MA
Enumeration Date: Oct 29, 2010
Last Updated: Oct 29, 2010

Practice Location

Address: 201 E LIBERTY ST
Address 2: SUITE 2
City: Ann Arbor
State: Michigan
ZIP Code: 48104-2118
Phone: (734) 330-3580

Specialties & Taxonomy Codes

Specialty	Taxonomy Code	Primary
Psychologist - Clinical — Clinical	103TC0700X	Primary

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