Ty Lamar Wallace, MSW
NPI #1295257624 in Pinckneyville, Illinois
Provider Information
- NPI Number
- 1295257624
- Entity Type
- Individual
- Name
- Ty Lamar Wallace, MSW
- Gender
- Not Specified
- Sole Proprietor
- Yes
- Primary Specialty
- Social Worker - Clinical
- Credential
- MSW
- Enumeration Date
- Jul 7, 2017
- Last Updated
- Jul 21, 2022
Practice Location
- Address
- 4904 BOWLS BOTTOM RD
- City
- Pinckneyville
- State
- Illinois
- ZIP Code
- 62274-2453
- Phone
- (618) 926-6050
Specialties & Taxonomy Codes
| Specialty |
|---|
| Social Worker - Clinical — Clinical |
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