Kelly Love Wallace, M. ED.

NPI #1124675749 in Edmond, Oklahoma

Provider Information

NPI Number: 1124675749
Entity Type: Individual
Name: Kelly Love Wallace, M. ED.
Gender: Not Specified
Sole Proprietor: Yes
Primary Specialty: Counselor - Professional
Credential: M. ED.
Enumeration Date: Aug 19, 2019
Last Updated: Aug 27, 2021

Practice Location

Address: 2817 STONEBROOK RD
City: Edmond
State: Oklahoma
ZIP Code: 73003-2105
Phone: (214) 600-3503

Specialties & Taxonomy Codes

Specialty	Taxonomy Code	Primary
Counselor - Professional — Professional	101YP2500X	Primary

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