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1609155571
LISA A WALLACE
DURANT, OK
NPI
1609155571
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Entity Type
Individual
Gender
Female
Sole Proprietor ?
Yes
Primary Taxonomy
101YM0800X Counselor, Mental Health
Enumeration Date
2011-08-10
Last Update Date
2011-08-10
Business Address
-- LISA A WALLACE
1604 N WASHINGTON AVE
DURANT, OK 74701-2128
Phone number: 580-920-0909
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Mailing Address
-- LISA A WALLACE
1604 N WASHINGTON AVE
DURANT, OK 74701-2128
Phone number: 580-920-0909
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