Stacy Lea Wallace, NCC

NPI #1003249848 in Pawnee, Oklahoma

Provider Information

NPI Number: 1003249848
Entity Type: Individual
Name: Stacy Lea Wallace, NCC
Gender: Not Specified
Sole Proprietor: No
Primary Specialty: Counselor
Credential: NCC
Enumeration Date: Aug 15, 2013
Last Updated: Aug 15, 2013

Practice Location

Address: 540 ILLINOIS ST
City: Pawnee
State: Oklahoma
ZIP Code: 74058-2036
Phone: (918) 762-1045

Specialties & Taxonomy Codes

Specialty	Taxonomy Code	Primary
Counselor	101Y00000X	Primary

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