Most Relevant Information
Provider Data
| NPI Number: | 1003249848 |
| Provider Name: | STACY LEA WALLACE NCC |
| Entity Type: | Individual |
| Taxonomy Code: | 101Y00000X |
| Specialty: | Counselor |
| License Number: |
Most Important Dates
| Enumeration Date: | 08/15/2013 |
| Last Updated: | 08/15/2013 |
Provider Practice Location
540 ILLINOIS ST
PAWNEE
OK
740582036
Practice Location Phone/Fax
| Phone: | 9187621045 |
| Fax: |
Provider Mailing Location
540 ILLINOIS ST
PAWNEE
OK
740582036
Provider Mailing Phone/Fax
| Phone: | 9187621045 |
| Fax: |