| NPI | 1639697535 |
|---|---|
| Former Name | JAYME R WALLACE |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101Y00000X Counselor (Licence: WY LPC-2112) |
| Additional Taxonomies | 171M00000X Case Manager/Care Coordinator |
| Enumeration Date | 2017-08-31 |
| Last Update Date | 2023-07-24 |