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1073859351
EVAN JAMES WALLACE
GRESHAM, OR
NPI
1073859351
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Entity Type
Individual
Gender
Male
Sole Proprietor ?
No
Primary Taxonomy
101YM0800X Counselor, Mental Health
Enumeration Date
2012-12-14
Last Update Date
2012-12-14
Business Address
Mr. EVAN JAMES WALLACE
360 SW 6TH ST
GRESHAM, OR 97080-9475
Phone number: 503-726-3806
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Mailing Address
Mr. EVAN JAMES WALLACE
8915 SW CENTER ST.
TIGARD, OR 97223
Phone number: 503-726-3740
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