Jerryd Wallace, LPC
NPI #1821573387 in Van Alstyne, Texas
Provider Information
- NPI Number
- 1821573387
- Entity Type
- Individual
- Name
- Jerryd Wallace, LPC
- Gender
- Not Specified
- Sole Proprietor
- No
- Primary Specialty
- Counselor - Professional
- Credential
- LPC
- Enumeration Date
- Oct 1, 2018
- Last Updated
- Oct 1, 2018
Practice Location
- Address
- 162 N. DALLAS AVE
- City
- Van Alstyne
- State
- Texas
- ZIP Code
- 75495-7549
- Phone
- (469) 667-3515
Specialties & Taxonomy Codes
| Specialty |
|---|
| Counselor - Professional — Professional |
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