Juanita Wallace
NPI #1326164278 in Florissant, Missouri
Provider Information
- NPI Number
- 1326164278
- Entity Type
- Individual
- Name
- Juanita Wallace
- Gender
- Not Specified
- Sole Proprietor
- Yes
- Primary Specialty
- Counselor - Mental Health
- Enumeration Date
- Mar 22, 2007
- Last Updated
- Jul 9, 2007
Practice Location
- Address
- 570 SHACKELFORD RD
- City
- Florissant
- State
- Missouri
- ZIP Code
- 63031-5457
- Phone
- (314) 583-0549
Specialties & Taxonomy Codes
| Specialty |
|---|
| Counselor - Mental Health — Mental Health |
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