MEDICARE: APRIL WALLACE

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YM0800X	Mental Health Counselor

General Provider Information

NPI Number	:	1548671480
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	APRIL WALLACE

Provider Business Mailing Address
First Line	:	605 W OXFORD AVE
Second Line	:
City	:	ENID
State	:	OK
Zip	:	73701-1208
Country	:	US
Telephone Number	:	580-233-7220
Fax Number	:

Provider Business Practice Location Address
First Line	:	605 W OXFORD AVE
Second Line	:
City	:	ENID
State	:	OK
Zip	:	73701-5408
Country	:	US
Telephone Number	:	580-478-5623
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/14/2014
Last Update Date	:	05/14/2014

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Directions to “ APRIL WALLACE ” Practice Location

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