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1710461868
LACEY JO WALLACE
SPRINGFIELD, MO
NPI
1710461868
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Entity Type
Individual
Gender
Female
Sole Proprietor ?
No
Primary Taxonomy
101YM0800X Counselor, Mental Health
(Licence: MO 2017030034)
Enumeration Date
2018-09-24
Last Update Date
2018-09-24
Business Address
Mrs. LACEY JO WALLACE MS, PLPC
2131 S EASTGATE AVE
SPRINGFIELD, MO 65809-2146
Phone number: 417-763-3309
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Mailing Address
Mrs. LACEY JO WALLACE MS, PLPC
2131 S EASTGATE AVE
SPRINGFIELD, MO 65809-2146
Phone number: 417-763-3309
Copy
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