| NPI | 1114472735 |
|---|---|
| Other Name | BECCA M WALLACE |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: OK 1272) |
| Additional Taxonomies | 103TC0700X Psychologist, Clinical (Licence: AR 1508APPL) |
| Enumeration Date | 2016-08-24 |
| Last Update Date | 2017-04-28 |