Lisa Wallace

NPI #1427463405 in Olympia Fields, Illinois

Provider Information

NPI Number: 1427463405
Entity Type: Organization
Organization Name: Lisa Wallace
Primary Specialty: Counselor - Mental Health
Enumeration Date: Jun 27, 2014
Last Updated: Jun 27, 2014

Practice Location

Address: 20200 GOVERNORS DR
Address 2: 107
City: Olympia Fields
State: Illinois
ZIP Code: 60461-1032
Phone: (708) 462-4235

Authorized Official

Name: LISA WALLACE, LCPC
Title: PROVIDER
Phone: (708) 906-0205

Specialties & Taxonomy Codes

Specialty	Taxonomy Code	Primary
Counselor	101Y00000X
Counselor - Addiction (Substance Use Disorder) — Addiction (Substance Use Disorder)	101YA0400X
Counselor - Pastoral — Pastoral	101YP1600X
Counselor - Professional — Professional	101YP2500X
Marriage & Family Therapist	106H00000X
Counselor - Mental Health — Mental Health	101YM0800X	Primary

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