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General NPI Number Information
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NPI Number | 1982229498
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Entity Type | Organization
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Legal Business Name | REBECCA WALLACE COUNSELING LLC
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Dates
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Enumeration Date | 06/10/2020
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Last Update Date | 06/10/2020
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Provider Practice Location Address
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Address Line | 207 PEACH WAY SUITE 110
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City | COLUMBIA
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State | MO
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Zip | 65203
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Country | US
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Telephone | 573-777-8775
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Fax |
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Provider Business Mailing Address
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Address Line | 1800 N GARTH AVE
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City | COLUMBIA
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State | MO
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Zip | 65202-1547
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Country | US
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Telephone | 314-308-0946
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | REBECCA WALLACE
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Credential | LPC
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Telephone | 314-308-0946
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM0801X
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Taxonomy Name | Mental Health Clinic/Center (Including Community Mental Health Center)
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License Number |
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License Number State |
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